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� <br /> Sec.13.04 RIGHTS OF SIJBJ�CTS OF DATA <br /> Subd. 1. Type of data. The righ[s of individual on whom the data is stored or co be stored shall be as set forth in this secdon. <br /> Subd.2. Information required to be given individual. An individual asked to suppiy private or confidential data conceming himself shall <br /> be informed of: (a)the pucpose aad intended use of the requested dara within the collecdng 3tate agency,polidcal subdivision,or statewide system; <br /> (b)whether he may refuse or is legaily required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)rhe idendry of other persons or endries authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individuai is asked to supply invesdgadve dara, punuant[o secdon 13.82, subdivision 5, [o a law enforcement officer. <br /> The commissioner of revenue mav �lace the nodce required under this subdivision in the individual income tax or prooertv tax refund <br /> instrucrions 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 subject <br /> of stored data on individuals,and whecher it is classified as public,private or confidendal. Upon his further request,an individual who is the subject <br /> of stored private or public dara on individuals shall be shown che data wichout any charge to him and,�if he desires, shall be informed of the contenc <br /> and meaning of that data. Aher an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acdon pursuant to this section is pending or addidonal dara on the individual has been co(lected or crea�ed. <br /> The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. T'he responsible aurhoriry <br /> may require[he requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The respoasible authoriry shall comply immedia[ely,if possible,with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc <br /> within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. <br /> The responsibie authority shall within 30 days either: (a)correc[the data found w be inaccurate or incomplete and attempt to noafy past recipients of <br /> inaccurate or incomplete data,inciuding recipients named by the individual;or(b)nodfy the individual that he believes the dara to be correct. Data <br /> in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. <br /> The detercnination of the responsible authoriry 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 pernut 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 fumish will be used to determine your qualification for the pemut 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 agencies to the eztent 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 /> wr Ir�►R-�^ ���-C �'J �-?��58r✓ <br /> Fint Middle Last <br /> J��7�- /��s�`N �9��- �w <br /> Address • <br /> �'�C/C. f21(J G� �J N - J���� � �� ���� <br /> C��, State Zip Phone <br /> I under and my rights as stated above. <br /> Si nature <br />