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� T <br /> . Sea 13.Q4 RIGHTS OF S[JBJECTS OF DAT.�► ' <br /> Subd. 1. Type of data. The righcs of individual on whom rhe dara is swced or ro be swced shall be u sec for[h ia this secrion. <br /> Subd.2. Informatioa required to be Yivm individual. An iadividual uked to supply privace or coafidendal dan concerning himte(f shall <br /> be info�uted of: (a)the purpose and iatended use of the requested dan withia the collecdng Stace agenry.political subdivision,or stacewide rystem: <br /> (b)whether he may tefuse ot is.legally cequiced to supply the ctquesud d,ata:(c)any Imown coauqueace arising ftom his supplying or refusing to supply <br /> private o�coafidendal data;and(d)the ideadry of o[het persoas or eaddes au[hocized by stace or federal(aw co Kceive the data. Zhis requitement shall <br /> noc apply when an individual is uked to supply invesdgadve daa,pursuant to secdon 13.82,subdivision S.oo a Iaw enfoccemeac officer. <br /> �� PI1TT�!l1f1RIr f1f rcvenu- mav Dlac- the nodc� rauired under this subdivision in the individual income taz or orovertv tax refund <br /> insnucdons inscexd of on ehose foims. <br /> Subd.3. Aceess to data by iadiridual. Upon request W a tesponsible aurhoriry,an iadividual shall be informed whether he is che subject <br /> of stoted data on individuals,and whaher ic is ctass�ed u public,private or confidendal. Upon his ti�cther requesc,aa iadividual who is the subjecc <br /> o[stored private ar public dara on iudividuals shall be shown che dan wirhout any charge to hun and;if he desires,shall be infocmed of the contenc <br /> and maning of dtat daa. Afu�an individual h�been shown the private dan and iaformed ot ics meaning.the data need not be disclosed o�him for <br /> iu months thereafur unless a dispute or acaon pursuanc to this ucdon is pending or addiaonal data on the individual has been collecced or crea�ed. <br /> The cesponsible aurhoriry shall pcovide copies of the privace or public dara upon request by the individual subject of the daa. 'Ihe responsible authoriry <br /> may require rhe requesring person to Pay the accual coscs of rsukin$,cerdfying,and compiling ehe copies. <br /> The responsible auchoriry shall comply immediacaly,if possible,wich aay cequest made pursuant to�his subdivision,or wichin five days of <br /> the date of die requesc,excluding Saturdays.Sundays and legal holidays,if immediate compliance is not possible. If he canao[comply with the tequest <br /> within thac ame,he shall so infocm the individual,and may have an addidoaat five days wi[hin wtuch oo comply wi[h the reques�excluding Satucdays, <br /> Sundays utd legal holidays. <br /> Subd.4. Procedure when data is not aceurate or eomplete. An individual may contest che accuncy or completeness of public or private <br /> data eonceming himsdf. To execcise this right,an indiviCual shall norify in wridng d►e responsible aurhoriry describing the natuce of the disagreemenG <br /> 'l�e nsQoasible authoriry shall within 30 days eicher: (a)correct the dan found ro be inaccunte or incomplete and attempc to norify past recipientt of <br /> inaccunte or incomplete data,iacluding recipienrs named by ehe individual:or(b)nodfy the individual thac he believes[he data to be cocrect Data <br /> in dispute shall be disclosed oniy if the individual's stacement o(disagreement is included with[he disclosed dara. <br /> The deurminadon o[the rasponsible au[horiry may be appealed puauanc oo the provisions of[he adminisaadve pcocedure act relacing to <br /> contesad cases. • <br /> DATA PRTVACY ADYISORY <br /> In accordance with M.S. 13.04, Subd.2, "RiQhts of subjects of data",we would like to inform you that your request <br /> for a permit or license from the City of Orono or any of ics departments may require you to furnish certain private or <br /> coafidencial information. <br /> You aze notified that: <br /> 1. The informatioa 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 tho Ciry deny the permit or license. <br /> 3. The information may be shazed with ocher local, state or federal agencies to the excenc necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council acdon 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 to process this application or permit. <br /> 4�i�i �— <br /> 5���„ �tiddle �� <br /> ��'�'D ���� �� ` !� <br /> Addre����1� l /� �"�( !'l/ ��G�� / �U� � <br /> Snu Zip Pho� <br /> ��ry �'�� -s���O <br /> I unde�st d y ' as stated ab � � — ��� ?� <br /> Sig ture <br />