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*f � <br /> Sec.13.04 RIGH'TS OF SLIBJECTS OF DATA <br /> Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. <br /> Subd.2. Information required to be given individual. An individuai asked to supply private or confidendal data concerning himself shall <br /> be informed of: (a) the purpose and intended use of the requested data within the collecdng'state agency, polidcal subdivision,or starewide system; <br /> (b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply <br /> private or confidenaal data;and(d)che idenciry of other penons or endries au[horized by state or federal law to receive[he data. This requirement shall <br /> not apply when an individual is asked to supply invesrigaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place [he noric� required under this subdivision in the individual income tax or proaertv tax refund <br /> instrucrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whether it is classified as public, privace or confidenaal. Upon his furcher request,an individual who is the subjecc <br /> of stored private or pubtic data on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed[o him for <br /> six months thereafter uriless a dispute or action pursuant to this secdon is pending or additional data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the Qrivate or pubfic data upon requesc by the individual subject of the data. The responsible au[horiry <br /> may require the requesting penon to pay the actual cosu 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 of <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 individua(,and may have an addidonal five days within which to comply wirh 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 priva[e <br /> data conceming himseif. To exercise this right,an individual shall notify in writing the responsible authoriry describing the narure of[he disagreement. <br /> The responsible authoriry shall within 30 days either. (a)correcc[he data found to be inaccurate or incomplete and attempt to nodfy past recipienrs of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is inc(uded wi[h the disclosed data. <br /> Tne detzrmination of the responsible authoriry may be appea(ed pursuant to the provisions of the administracive 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 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 determine 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 pernut 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 permit or license requires Council action to approve, some information may become <br /> public. <br /> $. You have certain righ[s under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (, Y full name is required to process this application or permit. <br /> C� ��� t <br /> First � /Middle Last <br /> /�^B�U � <br /> Address,^���'/'�� �l/ �«/�� �.GiJ.� �`�� v�✓`'' vU <br /> Ciry State Zip Phone <br /> I understand my rig ta d above. <br /> ' <br /> Signature <br />