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f f y <br /> Sec.13.04 RICHTS OF SUBJECTS OF DATA <br /> Subd. l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Infonnation required to be given individual. An individual asked to supply private or confidential data conceming himself shall be <br /> infonned of: (a)the purpose and intended use of the requested data wi[hin the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any la�own consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data. This 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 officer. <br /> 'ihe commissioner of revenue mav nlace the notice required under this subdivision in the individual income tax or vrooertv tax refund <br /> inctruetions inctead of on those fortns. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of <br /> stored private or public data on individuals shall be shovm the data without any charge to him and,if he desires,shall be infonned of the content and <br /> meaning of that data. After an individual has been shown the private data and info�med of its meaning,the data need not be disclosed to him for six <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. 'ilie <br /> responsible authoriry shall provide copies ofthe private or public data upon request by the individual subject of the data. The responsible authority may <br /> require the requesting person ro pay the actual costs of making,certifying,and compiling the copics. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe <br /> date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesl <br /> within that time,he shall so infonn the individual,and may have an additional five days within which to comply with the request,excluding Sa[urdays, <br /> Sundays and legai holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or piivate data <br /> conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The <br /> responsible authority shall within 30 days either: (a)con•ect the data found to be inaccurnte or incomplete and attempt to noti}'y past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in <br /> disputz shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The detennination oFthe responsible authority may be appealed pursuant to the provisions of 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 subjects of data",we would like to inform you that your request <br /> for a pennit or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidential infonnation. <br /> You are notified that: <br /> 1. The infonnation you furnish will be used to determine your qualification for the pennit or license <br /> requested. <br /> 2. You may refuse to supply data,but refusal may require that the City deny the pernut or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve,some infoimation 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 /> � � _ l l- <br /> � <br /> ��t;��,,;,;; �v,l ���t,�-� � �.:. w�.� ; ,,�i�! <br /> First Middle Last <br /> > ���.;� >r '�r"✓ d (��c�a v ��r, <br /> Address <br /> �� ��'?�? S�S �35 � �; �.�-�� ?,�-����f�� <br /> ���" J n � <br /> City Statc Zip Phone <br /> I understand my�rights as stated above. � <br /> . , � � <br /> j . _ <br /> '' .`.�--�-�� � -�;� <br /> ,-� ..- �f � � /�{lS <br /> Signature <br /> 32 <br />