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. � <br /> Sec.13.04 RIGKTS OF SUBJECTS OF DaTA ' <br /> Sabd. 1. Type o[data. The righcs of individual oa whom the data is smred or co be swrcd shalI be u sec focch ia this secrion. <br /> Subd.2. IntormaHon required to be givm tadi,•fdual. �1n iadividual uYed w suppty private or confideadal daa coacerniag himself sha21 <br /> be informed of: (a)the purposa aad iacended use of che requesred daa wirhia the eollecdng State ageary.poliacal subdivisioa.or sratewide rysum; <br /> _ (b)whe�er he may cetuse oti is,legally requir:d to supply the requesud data:(cj any Idsawu caauqueace arisiag from his supptying or reftuing to suppiy <br /> privace or confideaaa!data;and(d)the idendry o[o�her persoas or encdes auchacized by snce or federal law to trceive the data. 'Ihis requiremeac shall <br /> not appiy when an indiv.iduaI is uked to supply invesdgzdve daa,pursuanc to secdoa 13.82,subdivisioa S.w a law enfoccemeat ofScec. . <br /> The eer.imissioner of rcvenua mav otace che nodce r.auired undu chis subdivision in the individua! income tax or orooectv taz refund <br /> insaucdons inscead of on those forms. <br /> Subd.3. Aecess to data bv individuai. Upon rcquesc to a responsible authoriry,an iadividual shall be informed whether he is the subjecc <br /> of stored dae ort individuats,and whecher ic is classiFied u pubGc,privace oc confidencal. Upan his further requesc,aa iadividual who is rhe subjeu <br /> of stored privace or public daa on individuals shall be shown the dan wirhout any charge oo him and;if he desires,shalI be informed of the coatenc <br /> and meaning of chat data. Afur an individual has been shown the priva�e dam and iaforaud ot ict meaning,the dara need not be disclosed oo hua for <br /> siz mondu thereafur uniess a d'�spute or acdon pursuanc to this secdon is panding or addidona!dara on the individual has been coUeued or creared. <br /> Zhe responsible auehoriry shall'pcovide copies of the private or public daca upon cequest by the individual subject of the dara. The raponsible authority <br /> may require che requesdng person to pay the aceual cosu of making,cecdfying,and eomp'iling the eopia. <br /> The cesponsible authoriry shall eomply immediatety.if possibte,wich any tequest made pursuanc to this subdivision,or within five days of <br /> the date o[the cequesc.excluding Satutdays,Sundays and legal holidays,if immediace compliance is not possible. If he canaot eomply with the request <br /> wirhin chat dme,he shatl so inform the individual,and may have an addidoaal five days withia which to compiy wich the request,excluding Saturdays, <br /> Sundays and legal hotidays. � <br /> Subd.4. Procedure when data ts not aeeurate or eomplete. M iadividual may contest che accuracy or completeness of public or private <br /> dara conceming h'�msdf. To ezercise chis right,an individual shall aodfy ia wriciag the respoasible auchoriry describing che nature of the disagreemeac <br /> The respotuible authoriry shall within 30 days either: (a)correct che dara faund w be inaccurate or incomplete and atumpt to nodfy past recipiencs of <br /> inaceurate or incomptece data,including recipienct named by the individual:or(b)nadfy the individua!that he believes the data to be correcc Data <br /> ia dispute shall be disclosed only it the individual's stacement of disagreement is included wi[h the d'uclosed data. <br /> 'It►e decemunaaon of[he responsible auchoriry may be appealed pursuanc to the provisioas of the administradve procedun aet relaang to <br /> contesud cases. • <br /> DATA PRIVACY ADYISORY <br /> In accordance with M.S. 13.04,Subd.2, "Righcs of subjects of data"�we would like to inform you that your request <br /> for a permit or license from the Ciry of Orono or any of its deputments may require you to furnish certain private or <br /> confidential information. <br /> You aze 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 shazed with other local.state or federal a�encies to the ettent 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 (availabte upon request) to review private.data onyouurself. <br /> 6. Your 11 n is re ired to process this application or permi[. <br /> I <br /> Fitst �tiddle � L.ast <br /> �' �a �� 2�e� � .��Z <br /> Addreu l.,�( � �j � � � j<i��� �!� � <br /> Ciry Sate Zip Phoae <br /> I understand ri;hts a�s stated above. <br /> � . <br /> Signamre <br />