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; � _ <br /> Sea13A4 RIGATS OF S[JB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom che data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given individual. P+n individual asked to supply privare or confidenrial data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the requested data within the collecang'state agency,polilical subdivision,or statewide system; <br /> (b)whether he may refuse oY is legally required to supply che requested data;(c)any Irnown consequence arising from his supplying or refusing to supply <br /> priva[e or confidenaai data;and(d)the idendty of ocher persons or enrides authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesrieauve daci, pursuan�to secaon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund <br /> inscruccions instezd of on those forms. <br /> Subd. 3. Access to data by individual. Upon reques�to a responsibte authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whe[her it is classified as public, priva[e or confidendal. Upon his further request, an individual who is[he subject <br /> of stored private or public 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 that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or action pursuant to this section is oending or addioonal data on[he individual has been collected or creaced. <br /> The responsible au[horiry shall provide copies of the private or pubiic data upon request by the individual subject of che data. The responsible authority <br /> may require[he requesting person to pay the actual 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 of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wi[h the request <br /> within that time,he shall so inform the individual,and may have an additional 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 individua!may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise this ri¢ht,an individual shall notify in writing the responsible authoriry describing rhe nature of the disagreement. <br /> 'fhe responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomple[e and attempt to norify past recipienu of <br /> inaccurate or incomplete data, including recipiencs 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 statemen[of disagreement is included with[he disclosed data. <br /> The de[erminarion of the rzsponsible authoriry may be appealed 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 pernut or license from the Ciry 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 pemut or license 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 process <br /> the pernut 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 /> First �tiddie Last <br /> Address <br /> Ciry State Zip Phone <br /> I und rstand my rights as st�bove. <br /> /L ��✓�- <br /> Signature <br />