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r . � <br /> Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom[he data is scored or to be stored shall be as set forth in this secaon. <br /> Subd.2. Information required to be given individual. r1n individual asked to supply private or co�denaal data conceming himself shall <br /> be informed of: (a)the purpose and intended use of the requested data within the coliecring'state agency, polidcal subdivision,or statewide system; <br /> (b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising fi-om his supplying or refusing to supply <br /> private or co�denaal data;and(d)the iden[iry of other persons or entities authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigarive data, pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the notice required under this subdivision in the individua] income tax or propertv tax refund <br /> instrucrions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon reques[to a responsible auchoriry,an individual shall be informed whe[her he is the subject <br /> of stored data on individuals,and whether it is classified as public, priva[e or confidendal. Upon his further request, an individual who is the subject <br /> of stored private or pubtic data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content <br /> and meaning of[hat data. After an individual has been shown the privace data and informed of its meaning,the data need not be disclosed[o him for <br /> six months thereafrer unless a dispute or action pursuant to this secnon is pending or addidonal data on the individual has been collected or created. <br /> The responsible authority shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requescing person to pay the actual costs of making, cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days oi <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the reques[ <br /> within that time,he shall so inform the individual,and may have an addiaonal five days wi[hin which to comply with the request,excluding 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 individual shall notify in writing the responsible authority describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipieots of <br /> inaccurate or incomplete data, including recipiencs named by the individual; or(b) notify the individual that he belizves the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed dara. <br /> The determinacion of the responsibfe authoriry may be appealed pursuant to the provisions of the administraeive 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 pernut 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. T'he information you furnish will be used to determine your qualification for the pemut or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the pemut 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 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 to process this application or perm.it. <br /> � ���C � G�c:c �./ <br /> l//% / <br /> First 1 �e1 Last <br /> ,�5��j /��v s:�/� �� <br /> Address �� �/J� <br /> �r�>�t�'G �� N � �,� i ��U.� l <br /> C�n, State Zip Phone <br /> I understand my rights as stated above. <br /> ��s�fi'Y�c � �.��,f�/ <br /> Signature � ✓ <br />