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� <br /> , <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd.1. Type of data. Thc rights of individual on whom the data is sEored or to be stored shall be as set forth in this sectlon. <br /> Subd.2. Information required to be given individual. An individua►asked to supply private or confidential data concerning himself shali be <br /> intormed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivlsion,or statewide system;(b) <br /> whether he may retuse or is legally requlred to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or conFdential data;and(d)the identity of other persons or entities authorized by state or federal Iaw to receive the data. This requirementshall <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 /> The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income tax or proaertv tax refund <br /> instructions instead of on those torms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be intormed 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 sho�vn the data without any ciiarge to him and,if he desires,shall be informed of the content and <br /> meaning of that data. After an individual has been shown the private data and informed 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 coliected or created. The <br /> responsible autharity shall provide copies of the private or pubiic data upon request by the individual subject of the data.The responsible authority may <br /> require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately,if possibie,with any request made pursuant to this subdivision,or within five days of the <br /> date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot compiy with thc request within <br /> that time,he shall so inform the individual,and may have an additional Five days within which to comply with the request,exciuding Saturdays,Sundays <br /> and legal holidays. <br /> Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data <br /> concerning himselt. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The <br /> responsible authority shali wIthin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notity past recipients of <br /> inaccurate or incomplete data,including recipients named by the indivldual;or(b)notify the individual that he believes the data to be correct, Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination ot the 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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualiGcation 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 shared with other local,state or federal agencies 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 /> 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 /> r(/�� �,�.J � �ir�r� -,a/ <br /> First Middle Lasl� <br /> �d .� y� �� 1�,� .. c t <br /> Address <br /> ���,,` � �A,�..e �/��,_ S�S 3 y7 �s��ri'�r� 6��� <br /> City ` State Zip Phone <br /> I understand m rights�s stated above. <br /> r <br /> Signature <br />