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_ , Scc.l3.Od RIGHTS OF SUB3ECTS OF DATA Subd. L Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himselfshall be ' infonned of: (a)the purpose and intended use ot the requested data within the collecting state agency,political subdivision,or state�vide system;(b) whether he may refuse or is legally required to supply the requested data;(c)aip�known consequence arising from his supplying or refusin�to supply pri��ate or contTdential data:and(d)the identiry of other persons or entities authorized by state or federal Ia�v to receive the data. This requirement shal I not apply when an individual is asked to supply investieative data,pursuant to section 13.82,subdivision 5,to a la��enforcement officer. The commissioner of revenue ma_y_place the notice required under this subdivision in the individual income ta�or orooerri tax refund instnictions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is ciassitied as public,private or contidential. Upon his further request,an individual�vho 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 infonned of the content and meaning of diat 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 months thereaPter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifr'ing,and compiling the copies. The responsible aud�ority shal I comply immediately,if possibie,with any request made pursuant to this subdivision,or within tive days ot' the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addi[ional tive days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure 4vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notity in writing the responsible authority describing the nature of the disagreemenL The responsiblc authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notity the individual that he believes N�e data to be correct. Daca in dispute shall be disclosed only if the individuaPs sta[ement of disagreement is included with the disclosed data. The determination of the responsible authority ma}'be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a pennit or license from the City of Orono or any of its departrnents may require you to furnish certain�private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The infarmation may be shared with other local, state or federal agencies to the extent necessary to process the perntit or license. 4. If your requested permit or license requires Council action to approve, some information may become pubiic. 5. You have certain rights wlder NI.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. � ��-��d �Z�y� First J[iddlc LHst �ZZ� �� iP�"��e A�a��ss ' �.�v�.o ��n �� 3��f ��2 - �I�Z�� Citv State Zip Phone I understand my rights as stated above. �1 ��_�'�'� � s��;,t�r� _ Reset Form �'-