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. , � � �� <br /> �. . <br /> Sec.13.04 RIGHTS OF SiJBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secrion. <br /> Subd.2. Information required to be given indiridual. An individual asked m supply private or confidenaal data concerning himself <br /> shall be informed of: (a)the purpose az�d inre�Med use of the requesud data within the collecang state agency,political subdivision,or statewide <br /> rystem;(b)whether he may refuse or is legally required ro supply the requesud data;(c)any lmown consequence arising from his supplying or <br /> refusing to supply privare or confidenoal daa;a�(d)the idenaty of other persons or enades authorized by srate or federal law to receive the data. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav�lace the norice reauired under�h�s subdivision in the individ�al income tax or oro�ertv tax refund <br /> instrucrions mstead of on those forms. <br /> Subd.3. Access to data by iadividual. Upon request to a responsible authority,an individua!shall be informed whether he is the <br /> subject of stored data on individuals,and whether it is classified as public,privau or confidendal. Upon his further request,an individual who <br /> is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed <br /> of[he contenc and meaning of that data. Aher an individual has been shown the private data and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafter unless a dispute or acuon punvant ro this section is pending or additional data on the individual has been <br /> collected or created. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data. <br /> The responsible authoriry may require the requesdng person to pay the acmal cosu of making,certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately,if possibte,wirh any request made pursuant to this subdivision,or within five days <br /> of the da[e of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> the request within that dme,he shall so inform the individual,and may have an addiaonal five days within which to compty with the request, <br /> excluding Samrdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may coatest the accuracy or completeness of public or <br /> private data concerning himself. To ezercise this right,an i�Mividual shall nodfy in wriang the responsible authoriry deuribing the�nature of the <br /> disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or iiuomplete and attempt to noafy <br /> past recipiencs of inaccurace or i�omplete data,including recipients named by the individual;or(b)noafy the individual that he believes the data <br /> to be correct. Daa in dispute shall be disclosed oaly if the individual's statement of disagreement is included with the disclosed data. <br /> The determinadon of the respoiuible authoriry may be appealed pursuant to the provisions of the adminisorauve procedure act relating <br /> ro contested cases. <br /> �ATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the �iry of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You are notified that: , <br /> 1. The information you furnish will be used to determine your qualification for the permit or license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shazed with other local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> 4. If your requested pemut or licease requires Council action to approve, some information may become <br /> public. <br /> 5. You have certain rights under M.S. 13.04(available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> c—�vu� �-[�N r4�21� vW�2�Sa� <br /> First Middle �� <br /> _ ��3�-, C� o__��D A-� Sv <br /> Address <br /> l' �o� ��)�-,`f6� � i� 542_C) �tSZ $X`l 11 �� <br /> C�ry Srate Zip Phone •y� <br /> I under tand my rights as stated above. <br /> � <br /> Signature <br /> 6 <br />