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. � <br /> Sec.13.04 RIGHTS OF SLBJECTS OF D�1T�, <br /> Subd. l. Type of data. "Ihe riehcs of individual on whom cbe data is stored or to be stored shall be as sec foc-[h in this secdon. <br /> 3ubd.2. Information required to be�ven indicidual. .�n individual asked to supply priva[e or confidenaal data concerning hunself shall <br /> be informed of: (a) the purpose and in�er.dzd use oi the requested data wichin the collecdng'state agency, polidcal subdivision,or stacewide syscem; <br /> (b)whe[her he may reruse or is legally required to supply�e requested dara:(c)any Itnown consequence arising from tus supplying or refusing to supply <br /> private or confidenoal data:and(d)the idendry ot o[hez persons or enddes authorized by sta[e or federal law ro receive the data. This requiremen[shall <br /> not apply when an individual is asked ro supply invesnganve data, putsuanc to sectio❑ 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissione of reverue mav olace �e nonce -eauired under �his subdivision in the individual income taz or oropertv taz reTund <br /> ins�ructions insread of on those forms. <br /> Subd. 3. ?,ccess to data by individual. lioon reques[to a responsible auchority,an individual shall be inYormed whe[her he is the subjzct <br /> of stored data on individuals, and whecher it is classitieai as public, pnva[e or contidennal. lipon his further request, an individual who is the subject <br /> of stored pm�ate or public data on individuals shall be shown [he data without any cnaree to him and, if he desires, shall be informed of[he concenc <br /> and meaning of that data. :�fter an individual has been shown[he private data and informed of its meaning, the data need not be disclosed to hirn for <br /> six months thereatter unless a dispute or action pursuane to [his secnon is pending or addidonal data on the individual has been collected or crea[ed. <br /> The responsible au[honry shall provide copies of the pma[e or public data upon request by rhe individual subjecc of the data. The responsible authority <br /> may require the requestine person to pay [he actual costs of makin2, cemfyine, and compiling the copies. <br /> The responsible authoriry shall comply immedia[ely, if possible, wich any reauest made pursuan[to this subdivision, or within five days of <br /> the date of the request, excluding Sa[urdays,Sundays and legal hofidays,if immediace compliance is not possible. If he cannot comply with the request <br /> wi[hin tha[time,he snail so inform[he individual,and may have an addidonal five days within which ro comply with the request,excluding Sanirdays, <br /> Sundays and legal holidays. <br /> Subd.d. Procedure when data is not accurate or complete. An individual may con[est the accuracy or completEness of public or privace <br /> data conceming himseif. To exercise this rieht,an individual shall no[ify in writin;[he responsible au[hority describing the namre of the disagreement. <br /> The responsibte authority shall within 30 days ei[her: (a)correct the data found ro be inaccurate or incompiete and attempt to nodfy past*ecipients of <br /> inaccurace or incomplete data, including recipients named by the individual; or(b) nodty che individual tha[he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's sta�ement of disaereement is included wich the disclosed data. <br /> The de[erminadon of the responsible auchoriry may be appealed pursuant to the provisions of the admuusuadve procedure act rela[ing to <br /> contesred cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. Z, "Rights of subjects of data", we would like to inform you that your request <br /> for a permit or license from che City of Orono or any of its departments may require you to furnish certain pri��ate or <br /> confidential informa[ion. <br /> You a;e notif:ec cha[: <br /> 1, The information you furnish will be used to decermine your qualification for the permit or license requested. <br /> ?. You may reh:se to supply data, but refusal may require tha[ the City deny the permit or license. <br /> ;. The information may be shared with other local, state or federal a�encies to the extent 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 /> �. You have cercain rights under ti1.S. 13.04 (available upon request) to review private data on yeurself. <br /> 6. Your full name is required to process this application or permit. <br /> W��-�-��� G��6�� c��sn�1 <br /> First �iiddlz Last <br /> QOgo Gk�S�i�ZG- I�.��G-- - <br /> Address � ,-_ �^�q. <br /> PL`(�mov�'C� (Y1 I�Ncs��4 5��t�Cp C� 2 -5��- -� � <br /> City Stace Zip Phone <br /> I understand my rights as stated above. <br /> ��� �, �.���� <br /> Signature <br />