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Sec.13.04 RIGHTS OF SLIB.TECTS OF DaTa <br /> Subd. 1. Tvpe of data. The riehcs of individual on whom[he data is s[ored or�o be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply priva[e or confidendal data concerning himself shall <br /> be informed of: (a) the purpose and intended use of the requested data within the collecdng'state agency,political subdivision,or sratewide syscem; <br /> (b)whe�her he may refuse oY is legaliy required�o supply che requesced data;(c)any Irnown consequence arising from his supplying or refusing to suppty <br /> priva[e or conndendal data;and(d)the idenaty of other persons or endoes auchorized by state or fedecal law to receive the data. This requiremenc shall <br /> no[apply when an individual is asked to supply investieaave dara, pursuant to secdon 13.82, subdivision 5, [o a law enforcement officer. <br /> The commissioner of revenue r�av place the noace reauired under this subdivision in the individual income tax or propertv tax refund <br /> inscructions inscead of on chose forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible auchority,an individual shall be informed whether he is the subject <br /> of s[ored data on individuais,and wherher it is class�ed as public, privace or confidenrial. Upon tus further request, an individual who is the subjecc <br /> of s�ored privace or public data on individuals shall be shown the data wichout any charge to hun and,'if he desires, shall be informed of the concenc <br /> and meaning of�hac data. After an individual has been shown the priva[e data and informed of its meaning,the data need not be disclosed to him for <br /> six monrhs thereaiter unless a dispute or acrion pursuan�to this secrion is pending or addidonal data on the individual has been collected or creaced. <br /> The responsible au[horiry shali provide copies of the privace or public data upon request by the individual subject of�he data. The responsible authoriry <br /> may require the requesting person to pay the actual cosu of making,cerafying,and compiling the copies. <br /> The responsible authoriry shall comply immediatety, if possible, wi�h any request made pursuant to this subdivision,or within five days of <br /> the da�e of che reques�,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comp(y with the request <br /> within thac cime,he shall so inform the individual,and may have an addidonal five days wi[hin which to comply wi[h[he request,excluding Saturdays, <br /> Sundays ar.d legal holidays. <br /> Subd.4. Procedure when data is not accurate or camplete. An individual may contest the accuracy or completeness of public or pri�•ate <br /> data concerning himself. To exercise chis ri¢ht,an individual shall nodfy in wriang the responsible authoriry describing�he nature of the disagreemenc. <br /> The responsibte authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipien�s of <br /> inaccunte or incompiete data, including recipients named by the individual;or(b) notify che individual that he believes the data to be correct. Data <br /> in dispu[e shall be disclosed only if the individual's sta[ement of disagreement is included with the disclosed data. <br /> The de�erminarion of the responsible authoriry may be appealed pursuanc to the provisions of[he administrarive procedure act reladng 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 reauest <br /> for a pernu[ or license from the City of Orono or any of its departments may require you to furnish cenain private or <br /> confidential iniormation. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the pennit or license. <br /> 3, The information may be shared wich other local, state or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested pernut 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 ro process this application or permit. <br /> � ,.,;��-� <br /> �°� 1 �r ,, <br /> First � f Vtiddle Last <br /> ���j j �� �1.�i t` ,,1 v�� L�� <br /> Address <br /> `�\, -.�I l-�. �tv.,� �s v y� ��,=� .. ;��-����f <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> �. <br /> �_ L� s��� � -�-�..�-- <br /> Signature <br />