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� <br /> Sa_13.04 RIGHTS OF'SUBJECTS OF DATA <br /> Subd. 1. Type of data. "Ihe rigtits of individual on w6om fie data is stored or m be sm�ed s6all be as set focth m this secaoQ. <br /> Subd_2. Information required to be given iodividoai. pn iadividuai asked�o supplY Private or oonfideuaal data co�eruit�g himseif shall <br /> be iaforoud of: (a)the putpose and iatended use of thc�da�withia t6e cot(ecnng 3tau agoacy.Potrocal acbdivision,or statewide sysoem: <br /> (b)whefier he may refuse ot is legally required to supply che requested dara;(c)any Imown consecp�ence arising from�is supP�Y�B or refusing to suppty <br /> private or confideatial data;arni(d)the ideatity of other pe�soos or entities authorized by state or faknt faw in receive the data. This require�nt s6all <br /> �t apply when an individuat is asl:ed w svpply imesti�adve data,pacs�ant to secaon 13.82,svbdivision 5,w a�aw enforeemem offtcer. <br /> 'Fhe commissioner of revenue mav plact the ao6ce reauircd under this snbdivision in the individual income Cax or orooertv taz rtfiind <br /> inst�uctions ins[ead of on[hose forms. <br /> Subd.3. Acoess to data hy individuaL Upon ra�ucu oo a respons�bk aut6ority,an individual�all be i�ormed whether he is the sub�ect <br /> of stoced data on individuats,and whether it is classified as public,privau or coafidential. Upon Lis fucther request,an individuat who is the subject <br /> of stoced private or pub[ic data on ic�ividuals shall be shown the data without aay c6arge to him aad:if ha desires,sbal!be infoLmed of the content <br /> and meaning of[hat data. After an indiv9dual has been shown[he privane data ard informed of its meaning,t6e data need not be disclosed to him for <br /> six mondu theceafter unless a dispute or acdon pursuant to d►is secdon is pending or additional data on We individuai has been collected or created. <br /> The nsponsible audwriry shatl provide copies of the privarr or public data npon requac by the individuaI subject of the data. The responsible authoriry <br /> may require the requesting person w pay the acwal costs of making,cenifying,and compiGng the copies. <br /> The responsible audwriry shail compty irtu�dia�ely,if possible,with sny request made puesuaat to dus subdivision,or within five days of <br /> �he date af the request,ezcluding Satucdays,Svndays and legal holidays,if immediate compliance is not possib[e. If he cannot�mpty wiih the request <br /> within thac time,he shall so inform rh�ind"evidual,and may have an addidonai five days withiu which to comgly with tt�reques�ezcluding Saturdays, <br /> Sundays and legat holidays. <br /> �bd.4. Procedure when data ss mt accorate or complete. Aa individual tmy co�aest the ac,curacy or coaepleteness of public or private <br /> data concerning himself. To exercise this righi,an individual s6at1�tify ia writing d►e rcspoe►s�'ble suthoriry describmg the na[ure of d�e disagceement. <br /> 1he responsibie authority shall within 30 days either: (a)coriecc[he dara found oo be inaccurate or incomplete aad atrempt oo noddy past recipients of <br /> imccuraae or incomplete data,inciuding recipients named by the indiv�uai;or{b)notify the individual thac he believes the dara to be cocrecL Data <br /> in dis�wte shall be disclosed on(y if the individual's sratement of disagreement is included with ffie disclosed data. <br /> T6e deurminadon of the responsibte authoriry may be appealed pursuaat w the provisions of the admimsnative procedure act relating to <br /> oonoested cases. <br /> DATA PRIVACY ADYISORY <br /> In accordance with M.S. 13.Q4,Subd.2, "Rights of subjects of data",we wonld like to inform you that your request <br /> for a permit or licease from the City of Orono or any of its departments may require you to fiunish rertain private or <br /> wnfidential information. <br /> You are notified that: <br /> 1. The information you f�rnish will be used to deterntine yot2r qualification for the permit or Iicense 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 permit or iicense. <br /> 4. If your requested permit or license requires Couucil action to approve, some information may become <br /> public. <br /> 5. You have certain righcs under M.S. 13.04 (available upon cequest) to review private data on youiself. <br /> b. Your full name is required to process this application or permit. <br /> �3 r b�.✓'s2 S �ns,�e �J ' <br /> First Middle Lasc <br /> f��SD a �i r�e.. L�f. S • <br /> A� ss S,3 � 9�� ��� <br /> c;ty • stare zip . Phoae <br /> I understand my rights as stated above. <br /> �p-JI�-G � . <br /> s�gnaaue <br />