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r • <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. 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. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himselfshall be <br /> informed of. (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confiden[ial data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data This requirement shal I <br /> not apply when an individual is asked to supply imestisative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whether it is dassified 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 shown the data without any charge to him and,if he desires,shall be informed of the content and <br /> meaning of that data. After an individua]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 collected or created. The <br /> responsible authority shall provide copies ofthe private or public data upon request by the individual subject ofthe data. The responsible authority <br /> may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of <br /> the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If hc cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not aceurate or complete. An individual may contest the accuracy or completeness of public or private data <br /> concerning himsel£ To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement. The <br /> responsible authority shall within 30 days either (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;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 ofthe 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 qualification for the permit or license <br /> 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 <br /> process 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 /> First ! � , Middlc Last <br /> �` ' . , , ,( - <br /> �/ � ` �w <br /> . . �.���. ��� �� ° � i � ( �> �l f `�-� (�.'�i�; <br /> Address ,.� 1 <br /> �< <br /> '� � A_\ <br /> _. � - � , .-_ -. z <br /> . .� � , ' <br /> ' _�� �� 1 ���':��A_t,iv" ,��ti�ti�/- ` /�'? � � + �� �� � ' <br /> City •� State Zip Phone '���j ,� . - ;� �� <br /> � <br /> I understand my r ts as stated abo�e <br /> ,; <br /> I <br /> � _ �. � � <br /> Signature " <br /> � , � <br /> Reset Form a �, 32 <br /> y.�" �` <br />