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Sec.13.04 RIGHTS OF SUSJECTS OF DATA <br /> Subd.i. Type of data. Thc rights of individual on whom tlie data is stored or to be stored shail be as set Corth in this section. <br /> Subd.2. Information required to be given individual. An individual asked to supply pcivate or contidential data concerning himscl(shall be <br /> infonned of: (a)the purpose and intended use of the requested data�vithin the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may retuse or is Iegally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity of other persons or entities au[horized by state or federal latv to receive the data. This requirement shall <br /> not apply when an individua�is asked to supply im�estigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The commissioner ot revenue mav n�ace the notice reauired under this subdivision in the individual income tax or nronertv tax refund <br /> instructions instcad 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�vhether it is classi(ied as public,private or confldential. 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 charge to him and,if he desires,shall be informed o[the content and <br /> meaning of that data. A(ter an individual has bcen shown thc privatc data and informed of its meaning,the data necd 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 of the private or public data upon request by the individual subject of the data. The responsible authority may <br /> require the requcsting person to pay the aMual costs of making,certifying,a��d compiling tlic copies. <br /> The responsible authm-ity shall comply immediatcly,if possible,with any request made pursuant to this subdivision,or within five days of the <br /> date of thc request,excluding Saturdays,Sundays and legal holidays,if immediate compliancc is not possible. If he cannot comply with thc request witliin <br /> that time,hc shall so inform the individual,and may have an additional fivc days within which to comply with the requcst,excluding Saturdays,Sundays <br /> and Icgal holidays. <br /> Subd.4. Proccdure whcn data is not accin-ate or complete. An individual may contest the accuracy or complMeness of public or private data <br /> concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. Thc <br /> responsible authority shall within 30 days either: (a)con�ect the data found to be inaccurate or incomplete and attempt tu notiCy past recipients of <br /> inaccurate or incomplctc data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correcL Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is includcd with the disclosed data. <br /> 7'he detcrmination of the responsiblc authority may bc uppcaled pwsuant to the provisions of thc administrativc procedure act rclating 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 /> f'or a pernrit 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 pernut or license requested. <br /> 2. You may refuse to supply data,but refusal may require ttiat 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 yoursclf. <br /> 6. Your full name is required to process tliis application or permit. <br /> t�� ��� N �, �-y�� �� ! lcf�� V" <br /> First Middle Last <br /> � � �2 � TC, � (,v�� ��' �� . <br /> Addmss <br /> 1� 1'l� � i'�l.N � � �J � U �' � lZ - 7G � ` `f �K�Z <br /> City State Zip Phonc <br /> I understand my rights as stated above. <br /> ������ <br /> Signature <br />