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. <br /> Sec.I 3.04 RIGHTS OF SUBJECTS OF DATA � <br /> � <br /> Subd. I. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in Wis section. <br /> Subd.2. Information required to be given individual. An iodividual asked to supply private or confideatial data concerning himself shall be <br /> informed of: (a) the purpose and intended use of the requested data N�in the codecting state agency, political subd'aision, or statewide system; (b) <br /> whether he may refuse or is legally required to supply the requested data: (c) aar known consequence arising from his supplying or refusing to supply <br /> private or confidential data; and (d)the identity of other persons or entities author�d by state or federal law to recei►e the data. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to�ction 13.52,subdivision 5,to a law enforcem�t officer. • <br /> The commissioner of revenue mav place the notice reauired �der tbis subdivision in the individual income tax or orocertv tax reiund <br /> instructions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a rrspons�le authority, an individual shall be mformed whether he is the subject <br /> of stored data on individuals, and whether it is classified as public, private or coa�dential. llpon his further request, ae individual who is the subject ot <br /> stored private or public data on individuals shall be shown the data without any c6arge to him and, if he desires, s6a� be informed of the content and <br /> meaning of that data. After an individual has been shown the private data and �iormed of its meaning, the data need oot be disclosed to him for six <br /> months thereaFter unless a dispute or action pursuant to this section is p�.iing ar additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public data upon requesi by the indi��dual subject of the data. The responsible authority may <br /> require the requesting person to pay the actual costs of making,certitying,and�rompiTmg t6e copies. <br /> The responsible authority shall comply immediateh�, if possible,�ith aar request made pursuant to this subdi►ision, or within five days of the <br /> date of the request, excluding Saturdays, Sundays and legal holidays, ii imszdiate compliance is not possible. If he cannot comply with the request within <br /> that time, he shall so inform the individual, and may have an additional fne days within which to comply with the request, excluding Saturdays, Sundays <br /> and legal holidays. <br /> Subd. 4. Procedure when data is not accurate or complete. An odi�idual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise this right, an individual shall notih•� writic� the responsible authority describing the nature of the disagreement. <br /> The responsible authority shall within 30 days either: (a) correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or (b) notify the individual that he belie�es the data to be correct. Data in <br /> dispute shall be disclosed only if the ind'mdual's statement of disagreement is ia�uded vrith the disclosed data. <br /> The determination of the responsible authority may be appeal�f pur.�aat to the provisions oi the administrative procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of si:bjects 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 10�1, staie or federal agencies to the extent 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 public. <br /> 5. You have certain rights under M.S. 13.04 (available�pon request)to review private data on yoursetf. <br /> 6. Your full name is required to process this appli�tion or permit. <br /> �,-E�Jf�J ` r� r��-r� <br /> First Middle �t <br /> S��'J �O/ZIU/�/� C�/ L�..� �U � <br /> Address <br /> /�o u �J b �r� S��3,6�! -�i SZ �7 Z 7 3 �J <br /> City State Zip Pt�one <br /> 1 understand my ri ts as ated bove. <br /> Signature <br />