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3� <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subdivision/. Type of data. The rights of individual on tivhom the data is stored or to be stored shall be as set forth in lhis section. <br /> Subd.2. Injormation required to be given individuaL An indivrdual asked to supply private or confrdential data concerning hrmself <br /> shal!be informed of.' (a)the purpose and intended use of the requested data wrlhin the co/lecting state agency,politica!subdrvrsron,or statewide <br /> system;(b)whether he may refuse or is legally required to supply the reguested data;(c)any knotivn consequence arrsing from his supplying or <br /> refusing to supplyprivate or conftdential data;and(dJ the identity of other persoxs or entrtres authorized by state orfedera!law to receive the data. <br /> Thls requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision S, to a lmv <br /> enforcement o�cer. <br /> The commissioner of revenue mav place fhe notice required under this subdivision in Ihe indrvidual income tax or propertv[ax rerund <br /> rnstructrons instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authorrty,an individual shall be informed whelher he is the s:�bject <br /> of stored data on individuals, and whether it is classifted as public,private o�confrdentral. Upon his further request,an individual who is the <br /> subject of stored private or p:�blic data on indivrduals shall be shoivn the dala ivrthout any charge!o him and, rjhe desrres,shall be injormed of <br /> the content and meaning of that data. After an indivrdual has been shown the priva[e da�a and injormed of its meanrng, the data need not be <br /> disclosed to him for srx months thereafter unless a dispute or action pursuant to this sectron is pending or additiona!daJa on the individ:�a!has <br /> been eollected or created. The responsible authoriry shall provide copies of the private or publrc data upon request by the indivrdua!srabject of <br /> the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compi[ing the copres. <br /> The responsible authority shall comply immediately,if possible,with arry request made pursuant to this subdivision,or tivilhin five days <br /> ojthe date ojthe request,excludingSaturdays,Sundays and legal halidays,rf immediate compliance is not possible. Ifhe cannot comply ia�ith the <br /> request within that time,he shall so inform the individual,and may have an additronal five days tivithin whrch to comply ivith the request,excludrng <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. Ptocedure when data is not accura[e or complele.An individual may contest the accuracy or completeness ofpublrc or private <br /> data concerning himselj To exercrse thrs right, an individua!shal(notrfy rn writrng the responsible aurhorrry descrrbing the nature oJ'the <br /> disagreement. The responsible authorrty shall withrn 30 days either. (aJ correct!he datafound to be rnaccurate or incomp/ete and at[empt to notrfy <br /> past reciprents of inaccurate or rncomplete data,including recipients named by the indrvidual;or(bf notify the individual that he believes the data <br /> to be correct. Data in dispute shal!be disclosed only if the individual's statement of disagreement is included tivith the disclosed data. <br /> The determinatron of the responsible authority may be appealed pursuant to the provisions of the admrnistrative procedure act relating <br /> to contested cases. <br /> DATA PRIVACYADVISORY <br /> In accordance ivith M S.l3.04,Subd.2, "Rrghts ofsubjects ofdata",tive ivould like to injorm you that your requestfor a permit or license <br /> from the Ciry of Orono or any of its departments may requrre you to jurnrsh certain private or confidential lnformation. <br /> You are notified that.• <br /> 1. The information you furnish wif!be used to determine your qualifrcatron for the permit or lrcense requested. <br /> 2. You may refuse to supply data,but refusal may requrre that!he Ciry deny the permit or lrcense. <br /> 3. The rnjormation may be shared with other local,state or jedera!agencres to the extent necessary to process the permit or <br /> lieense. <br /> 4. If your requested permit or license requires Council action to approve,some injormatron may become public. <br /> 5. You have certain rights under M S. l3.04(see folloiving page)to revielv private data on yourself. <br /> 6. Your jul!name is requrred to process thrs application or permit. <br /> PLEASE PRINT <br /> �/L✓t.�i Z"J� ��. �.Jc=�'Z <br /> First Middle Last <br /> ��G 5 ��v� f��� :�� <br /> Address <br /> ,/I�e�/C� rrltil �5.����- <br /> Crty State Zip Phone <br /> % <br /> �unde stand my rrghrs as stated abo e. <br /> � <br /> ature <br /> �� 10 <br />