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1 <br /> Szc.13.04 RIGHTS OF SUB.TECTS OF DATA <br /> Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as set forrh in this section. <br /> Subd.2. Informatioa required to be given indiridual. An individual asked ro supply private or confidencial data conceming himseif <br /> shall be informed of: (a)the purpose and intended use of the requested data within the colleccing state agency,polidcal subdivision,or statewide <br /> system;(b)whecher he may refuse or is legally required to supply the requested data; (c)any lmown consequence arising from his supplying or <br /> refusing rD supply private or confidenaal dara;and(d)the idenury of other persons or enddes authorized by sate or federal law to receive the data. <br /> "I�is requirement shall not apply when an individual is asked to supply investigadve 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 this subdivision in the individual income taz or nrooem tax refund <br /> inscrucrions 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 furrher request,an individual who <br /> is the subject of s[ored private or public dara on individuals shall be shown the data without any charge to him and, if he desires,shall be informed <br /> of the content and meaning of that data. Aher an individual has been shown the private data and informed of its meaning,the data need not be <br /> disclosed co him for six months thereafrer unless a dispute or acdon pursuant to this secaon is pending or addirional data on the individual has been <br /> collzcted or created. The responsible authoriry shai(provide copies of the private or public data upon request by the individual subject of the data. <br /> Th:responsible au[horiry may require the requesdng person to pay the actual costs of making,certifyin„and compiling the copies. <br /> The responsibie authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or wi�hin five days <br /> of[he date of the request,excluding Sacurdays, Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply wirh <br /> ::e request wichin that dme, 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 comp(eteness of public or <br /> privare dara conceming himse(f. To exercise this right,an individual shail noufy in writing the responsible authoriry describing the nature of the <br /> disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found co be inaccurate or incomplete and attempt to nodfy <br /> past recipienrs of inaccurate or incomp(ete data,inctuding recipients named by the individual;or(b)nodfy 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 /> "Ihe determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrauve procedure act relaan, <br /> to conresced cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance wi[h 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 City of Orono or any of its departmen[s may require you to furnish certain <br /> private or confidential information. <br /> You are notified that: <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 agencies 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 /> �. 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 /> C Ji�cu.0 ib � � Fi�v h�c <br /> �rst bfiddle Last <br /> 3�-�b�5 i����� �. �u <-�,�. <br /> Address <br /> _lj?"��vGf-/�!(�C.0 �+itJ �G`1C�C, /7�i�G-`G�`�'�v�`� <br /> C��� S�ate Zip one <br /> I und d my ri ts as sta d above <br /> - �.J <br /> � � <br /> Signature <br /> � <br /> 6 <br />