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Sec.13.04 RIGHTS OF S[JBJECTS 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 secdon. <br /> Subd.2. Information reqirired to be given individual. .�+n individual asked to supply private or confidenrial data cooceming himself shall <br /> be informed of: (a)the purpose and iatended use of the requesud data wirhin the collecting"state agency,poliucal subdivisioo,or statewide system; <br /> (b)whether he may refuse or is lega(ly required to supply the requested data;(c)any irnown consequence arising from his supplying or refusing to supply <br /> priva[e or confidential data;and(d)the idenriry of o[her persons or enriries authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesd¢adve data, pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or property tax refund <br /> instructions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whecher ic is classified as public, private or confidendal. Upon his further request,an individual who is the subject <br /> of stored private or public dara on individuals shall be shown the data without any charge to him and,if he desires, shall be informed of the content <br /> and meaning of rhat data. After an individual has been shown[he private data and informed of iu meaning,the dara need not be disclosed to him for <br /> six months thereafrer unless a dispute or acaon pursuanc to this secdon is pending or addidonal data on the individual has been collected or created. <br /> The responsibie authoriry shail provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesdng person to pay the actual coscs of making,cerrifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or prn�are <br /> data conceming himself. To exercise this right,an individual shall nodfy in wriring the responsible authoriry describing che nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct[he data found to be inaccurate or incomplete and attempt to nodfy past recipienu of <br /> inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the individual thac he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible authoriry may be appealed pursuanc to the provisions of the administradve procedure act relacing to <br /> contested cases. <br /> DATA 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 reques[ <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 extent necessary to process <br /> the pemut 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 permit. <br /> � "�, <br /> �!/�� ,(k-y � � ��� �-G ��-= ��t <br /> First Middle -� Last <br /> 3�� � � ��� L � � ��� <br /> Address� <br /> J� � d�-�2 �2 � /�( �J �� �i� -z <br /> �i�, State Zip Phone <br /> I understand my rig ts as sta d ove. <br /> � <br /> - ,_--------.-.,.---- <br /> Signature <br />