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• <br /> _ . <br /> Sec.13.04 RIGH'TS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or ro be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqwred to be given individual. M individual asked to supply private or confidendal data conceming himself shali <br /> be informed of: (a)the pu�pose and intended use of the requested data within the coliecting rtate agency,poliacal subdivision,or sratewide sysum; <br /> (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idenrity of other persons or enrities authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesdgative dara, pursuant to section 13.82, subdivision 5,to a law enforcement o�cer. <br /> The commissioner of re�•enue mav place the nodce required under this subdivision in the individual income tax or propertv taz refund <br /> instructions instead 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 <br /> of stored data on individuals,and whether it is classified as public, private or confidendal. Upon his further request,an individual who is the subject <br /> of stored private or public data on individuals shall be shown the data without 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 iu meaning,che data need not be disclosed to him for <br /> six months thereafter unless a dispute or acaon pursuant to this secaon is pending or additio�al data on the individual has been collected or created. <br /> The responsib(e authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority <br /> may require the requesting person to pay the actual cosa 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 of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addiaonal five days within 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 nodfy in writing the responsible authority describing the nature of the disagreement. <br /> The responsible authority shall within 30 days either. (a)correct the data found ro be inaccurate or incomp(ete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data ro be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinadon of the responsibfe authority may be appealed pursuant to the provisions of the administradve 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 request <br /> for a permit 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 detemune 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 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 pemut 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 perm.it. <br /> �.� �� � ��, i,�,�f ���'\;: _r �, � ,"r_ ' �� `'_ � �P� <br /> � ' Last <br /> �irst � r.,` � Middle <br /> � / � �J �� � C -'` �i <br /> Ad ss � � �` , . � _ - _`.. ! <br /> � � [ �1� , � , i <br /> i" ��� `v'�1J 1;�:�,� I �-�_l�� � � ; , -;x � _ �-, , �. ,- <br /> City� State ip Phone ' <br /> /�derstand my rights as stated above. �` � <br /> � � � � � � , <br /> � <br /> �_� , � ,� �_-�, <br /> ::a�� �� � t �� � �� <br /> Signanire ' — � <br />