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Sec.13.04 RIGHTS OF SLIBJECTS OF DATA <br /> Subd. 1. Type of data. 'Ihe righ[s of individual on whom[he data is storcd or co be stored shall be as set forth in this section. <br /> Subd.2. Information reqirired to be given indiridual. An individual uked to suppiy privace or confidenrial dara concerning himseif shall <br /> be informed of: (a)the purpose and in[ended use of the mquesud data within the collecdng"stace agency,polidcal subdivision,or sratewide rysum; <br /> (b)whe[her he may refuse oY is legaliy required to supply[he requested data;(c)any Irnown coasequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idenary of other persoas or enddes auchorized by sta[e or federal law to receive the data. T'his requirement shall <br /> not apply when an individual is asked to supply invesrigadve daa,pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav place the nouce reauired under this subdivision in the individual income tax or Qropem raz rofund <br /> instructions inscead of on chose forms. <br /> Subd. 3. Access to data by individual. Uport requesc to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stoced data on individuals,and whe[her it is class�ed as public,privace or confidenaal. Upon his furcher requesc,an individual who is the subject <br /> of stored private or public data on individuals shall be shown che da[a wi�hout any charge to him and,if he desires, shall be informed of the content <br /> and meaning of chat data. Afrer 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 thereaher unless a dispute or acdon punuanc to this section is pending or addidonal data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the priva[e or public data upon request by the individual subject of[he data. The responsible authoriry <br /> may require[he requesdng person to pay the actual coscs of making, certifying, and compiling the copies. <br /> The responsible auchoriry shall comply immedia[ely,if possible, wich any requesc made pursuant to this subdivision,or within five days of <br /> the date of the request,exciuding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot comply with the requesc <br /> wichin that dme,he shall so inform the individual,and may have an addidonal five days within which to comply wich the request,exeiuding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private <br /> data conceming himself. To exercise this right,an individuai shall nodfy in wriang[he responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccu�ate or incomplece and attempt to noafy past recipienu of <br /> inaccurate or incompiete data, including recipients named by che individual; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if[he individual's statemertt of disagreement is included wi[h the disclosed data. <br /> The determinarion of the responsible auchoriry may be appealed punuanc to the provisions of the administrarive procedure act relacing to <br /> contesred cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data", we would like to inform you that your request <br /> for a pemut 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 deternune your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. <br /> 3. The information may be shared wich other local, state or federal agencies to the extent necessary to process <br /> the pernu[ 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 ri;hts 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 /> ��/iN � /.c��i'�� ���i� J� <br /> Firs[ _ Viiddle Last <br /> � �-�,� t�.� ��< �.�IY ��n,4r? <br /> i� ✓ � ; .; ,r'_ <br /> Address ? ..� �/��"�rl�/f <br /> C�/�!3 �,�/1 �7,t� �"�.�� ' 7` � <br /> ' City Srare Zip Phone <br /> 1 <br /> � <br /> �� I understand my rights as stated above. <br /> ' i�9G�E� <br /> acure <br /> ,, <br /> � <br /> � <br />