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Sec.13.04 RIGHTS OF SUBJECTS OF DATA � <br /> Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored s6a11 be as set forth in t6is section. <br /> Subd.2. Information requfred to be given individual. An indlvidusl uked to supply prtvate or rnntidential data concerning hlmself shall be <br /> intormed ot: (a)the purpose and intended use ot the requested data wlthin the rnllecting state agency,political subdivislon,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or rnnfidential data;and(d)the identity of other persons or entities aut6orized by state or tederal law to receive t6e data. Th➢s requirement shall <br /> not apply when an Individual is asked to supply Investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement of�cer. <br /> The rnmmissioner of revenue msv ulace the notice reauired under this subdivision in the individual income tax or orouertv taa re[und <br /> Instructions instead of on those torms. <br /> Subd.3. Access to data by individual. Upon request to a responsible suthority,an individual shall be informed whether he is t6e subject of <br /> stored data on indlviduals,and whether lt is classified as public,private or rnofideatial. Upon 6is turther request,an individual who is the subject of <br /> stored private or pubilc data on individuals shall be shown the data wit6out any c6arge to him and,if he desires,s6a11 be informed of the rnotent and <br /> meaning oi that data. After an Individusi 6as been shown the private data and informed of its meaoing,the data need not be disclosed to 6im for six <br /> months thereafter unless a dispute or action pursuant to this section ls pending or addlttonal data on the individusl has been rnllected or created. T6e <br /> responsible authority shall provide copies of the private or public data upon request by the individusl subject otthe data. The responsible sut6orlty may <br /> require the requesting person to pay the actual costs of making,certifying,snd rnmpiling the copies. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdlvision,or within five days of the <br /> date of the request,excluding Saturdays,Sundays and legal6olidays,ii immediate compllance is not possible.If he cannot comply with t6e request withln <br /> that time,he shall so inform the individual,and may have an additional tive days within whic6 to comply with the request,excluding Saturdays,Sundays <br /> and legal holidays. , <br /> Subd.4. Procedure w6en data is not accurate or rnmple�e. An iudividusl may contest the accuracy or completeness of public or private data <br /> concerning himself.To exercise this right,an individual shall notify in writlog the responsible authority descrlbing the nature of the disagreement. The <br /> responsible authorlty shall within 30 days either: (a)correct t6e data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or lnrnmplete daka,including recipients named by the Individual;or(b)notify the individual that he belleves the data to be correct. Data in <br /> dispute shall be disclosed only if the individual�s statemeot of disagreement is included with the�disclosed data. <br /> The determination of the responsible authorlty may be appealed pursuant to the provisions oi the administrative procedure act relating to <br /> rnntested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S.13.04,Subd.2,"Rights of subjectr of data",we would like to inform you that your request <br /> for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> 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 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 shared with other local,state or federal agencies to the eztent necessary to process <br /> the permit or license. <br /> 4. If your requested peraut or license 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 /> 06�Gx� <br /> First Mlddle Last <br /> /1 0' . / /1�f/t/YJ�- � . . . <br /> Address <br /> n� S�✓�� ! z - - ��' <br /> City State Zip Phone <br /> I understand my rights as stated above. • <br /> � i <br /> S gnature <br />