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! F <br /> � , <br /> Sec.13.04 RIGHTS OF SITBJECTS 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 for[h in this secdon. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data concerning himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,po(idcal subdivision,or sratewide <br /> rystem;(b)whether he may refuse or is legally required to suppty the requested dara;(c)any Irnown consequence arising from his supplying or <br /> refusing to supply private or confidenaal dara;and(d)the idendry of other persons or entiaes authorized by srate or federal law to receive the dara. <br /> This requirement shall not apply when an individual is asked to suppiy invesrigative data, punuant to secrion 13.82, subdivision 5, to a law <br /> enforeement o�cer. <br /> Th�commissioner of revenue mav olace the notice reauired under this subdivision in the individual income taz or orooem 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 <br /> subject of stored data on individuals,and whether it is classified as public,private or co�dentiai. Upon his further request,an individual who <br /> is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires,shall be informed <br /> of the content and meanin�of that data. Afrer an individual has been shown the private data and informed of its meaning, the data oeed not be <br /> d'uclosed to him for six months thereaher uriless a dispute or acdon pursuant to this secdon is pending or addiaonal data on the individual has been <br /> collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. <br /> The responsible auchority may require the requesring person to pay the actual cosu of making,certifying,and compiling the copies. <br /> 'Ihe responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days <br /> of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> the request within that time, he shall so inform the individual, and may have an addidonal five days within which to comply with the request, <br /> excluding Saturdays, 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 <br /> private data conceming himself. To exercise this right,an individual shal]noafy in writing the respoeuible authoriry describing the nature of the <br /> disagreemenc The responsible authoriry shall within 30 days eicher: (a)correct the data found to be inaccurate or incomplete and attempt to noafy <br /> past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)norify the individual that he befieves the daCi <br /> to be correct. Dara in dispute shall be disclosed oniy if the individual's statement of disagreement is included with the disclosed data. <br /> The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administraove procedure act relaang <br /> to contested cases. <br /> D.�TA PRIVACY ADVISORY <br /> In accordance wi[h M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the �ity of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You are notified that: <br /> 1. The information you fumish will be used to determine your qualification for the permit or license <br /> 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 <br /> process 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 t process this application or pe <br /> � �,� - <br /> First iddle Last <br /> i �3 8�� �\. � `� <br /> Address <br /> �' I�� l �2 Z�ZZ <br /> C�ry State Zip Phone <br /> I understand s as state b v . <br /> Signature <br /> 6 <br />