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, ! <br /> Sec.13.04 RIGHTS OF SCTBJECTS OF DAT.+► <br /> Subd. 1. Type of data. Ihe righcs of individual on whom[he data is stoced or ro be stoczd shall be as sec forch ia this secdon. <br /> Subd.2. Information reqirired to be givea individual. An individuai asked w supply privace or confidenrial data concecning himself shall <br /> be informed of: (a)the purpose and imm�ded use of�he requuud data within the collecdng Stare ageacy,polidcal subdivision,or scacewide rysum: <br /> (b)whecher he may refuse ot is tegally cequired to sappty che requesud data;(c)any Imown coasequence arising from his supplying or refusing to supply <br /> private o�confidenoal dara:and(d)che idenary of orher penoac or enddes authorized by srace or federal iaw to ceceive the data. This requiremenc shali <br /> not apply when an individual is asked to supply invesogadve dan,punuant ro secdan 13.82,subdivision 5, w a law enforcement officer. <br /> The commissioner of rcvenue mav vlace the nodce �zwired under rhis subdivision in the individual income tax or propem tax refund <br /> instrucdons instead of on[hose forms. <br /> Subd.3. Aecess to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of swred dara on individuals,and whe[hu it is classified as public, private or confidendal. Upoa his further request,an individual who is the subjecc <br /> of store�i private or public daa on individuals shall be shown rhe dara wichout any charge to him and;if he desires,shall be informed of the contenc <br /> and meaning of rhat data. After an individuai has been shown the privace daea and infarmed of ics meaning,the daa need not be d'uclosed w him for <br /> six monchs thereafur unless a dispute or acdon pursuanc to this secdon is pending or addiaonal dara on the individual has been collected or created. <br /> 'Ihe responsible authoriry shall provide copies of[he private or public data upon request by the iadividual subjecc of the dara. The responsible authoriry <br /> may require the requesdng person ro pay the acaal cos�s of making,cerdfying,and compiling the copies. <br /> The responsible auchoriry shall comply immediately,if possible,wich aay nqucsc made purruant to this subdivision,or within five days of <br /> the date of rhe request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with�he requesc <br /> wiehin that ame,he shall so inform the individual,and may have an addiaonal five days within which to compiy wich�he request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or completeness of public or private <br /> data concerning himself. To exercise[his right,an individual shall nodfy in writing rhe responsible au�horicy describing the naare of the disagreemenc. <br /> The responsible auchoriry shall wirhin 30 days either: (a)correct the data found to be inaccurate or incomplae and atumpc to nodfy past recipienu of <br /> inaccurate or incomplece dara, including recipiencs named by che individual:or(b}notify the iadividual thac he believes[he dara to be correct. Data <br /> in dispute shall be disclosed only if che individual's stacemenc of disagreement is included with the disclosed data. <br /> The decerminadon of the responsible auchoriry may be appealed punuanc to the provisions of the admuusaadve procedure act relating w <br /> contesud cases. <br /> . DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Rig.hts of subjects of data",we would like to inform you that your request <br /> for a pemut or license from the Ciry of Orono or any of its departments may require yo�to fumish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. T'he 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 shazed wich other local, stace or federal agencies to the ex[ent necessary to process <br /> the permit or license. <br /> 4. If your requested permit 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 permi�. <br /> V i�'YD�iR � �o � �v� �y <br /> - Firsc���d ��' �iiddle i`� `/�� Last <br /> � ilif, �i � o <br /> Addres�!/v ��� �l� ��� �/ /� � �/�� <br /> Ciry Scate Zip Phone <br /> I understand my ri s as stated above. <br /> � <br /> Signature <br />