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� . <br /> r � <br /> Sec.13.04 RIGFiTS OF SIJB.TECTS 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 secuon. <br /> Subd.2. Information required to be given indiridual. An individual asked to supply private or confidenpal data conceming himself <br /> shall be informed of: (a)[he purpose and intended use of the requested data within the collecdng state agency,polidcal subdivision,or statewide <br /> rystem;(b)whether he may refuse or is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or <br /> refiuing w supply privar�or confidential dam;and(d)the idendry of other persons or endries authorized by state or federa(law to receive the data. <br /> This requirement shall not apply when an individual is asked to supply investiga6ve data, pursuant to secdon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav olace the norice reouired under[his subdivision in the individual income taz or orooem tax refund <br /> instrucrions mstead 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 <br /> subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who <br /> is the subject of stored private or public data on individuals shall be shown the data without any char�e to hun and,if he desires,shall be informed <br /> of the content and meanin�of that data. Aher an individual has been shown the private data and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secoon is pending or addirional dara on the individual has been <br /> collected or created. The responsible authority shall provide copies of the private or public data upon reques[by the individual subject of the data. <br /> The responsible authoriry may require the requesring person to pay the acrual cosu of making,certifying,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 <br /> of the dace of the request,excluding 5aturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with <br /> thz request within that cime, he shall so inform the individual, and may have an addirional five days within which to comply with the request, <br /> excluding Saturdays, 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 <br /> private dara conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nacure of the <br /> disagreement. The responsib(e authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy <br /> past recipients of inaccurate or incomplete dara,including recipients named by the individual;or(b)nocify the individual that he believes the data <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminis�aave procedure act relaang <br /> to 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 <br /> request for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You are notified chat: <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 a?encies 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 /> Jos�;� ►�-y �� <br /> First / � A ' � Middle �{ i Last <br /> /� x'15-� <br /> Address <br /> �r�c �''�'I �53s7� ���-�1� ��/ <br /> C��Y State Zip Phone <br /> I underst my rights as stated above. <br /> Signa <br /> 6 <br />