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y • , <br /> Sec.13.04 R[GHTS OF SUBJECTS OE DATA <br /> Subd. 1:..:Tjpe of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Information requiced to be given individual. An individual asked to supply private or confidentiai data conceming himself shall be <br /> inforcned o£ (a)the purpose and iniended use of the requested data within the collecting state aJency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is iegally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private oi�confidential data;and(d)the identity of other persons or entities authotized by state or federal]aw to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The coinmissioner of revenue mav olace the notice required under this subdivision in the individual income tax orpi•o�ertv tax refund <br /> instructions instead of on those fonns. <br /> Subd.3. Access to data by individual. Upon request to a responsible autho�iry,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whether it is ciassified as public,private or confidential. Upon his further request,an individual who is the subject of <br /> stored private or pubiic data on individuals shall be shown the data without any charge to him and,if he desires,shall be infottned of Yhe content and <br /> meaning of that data. After an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to hnn for six <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been coliected or created. The <br /> responsible authority shall provide copies of the p�ivate or public data uponrequest by the individual subj ect of the data. The responsible authority may <br /> require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authority shali comply iRunediately,if possible,with any request made pursuan:to tYus subdivision,or within five days of the <br /> date of the request,excluding Saturdays,Sundays and legal holidays,if unmediate compliance is not possible. If he cannot comp]y with the request <br /> within that time,he shall so infonn the individual,and may have an additional five days within which to comply wi,h the request,exc]uding Saturdlys, <br /> Sundays and legaf holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compieteness of public or private data <br /> conceming himself. To exe�•cise this iight,an individual shall notify in writing the responsible authority describing the nature of the disa�•eement. The <br /> responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate er incomplete data,including recipiens named by the individual;or(b)notify the individaal tl:a:he believes the daa to be co;:e;.t. Da;a in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The detennination of ihe responsible authority may be appealed pursuant to the provisions of the administrative 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 pe.-mit or license from the City of Orono or any of its departments may require you to fiunish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The infonnation you furnish will be used to detennine your qualification for the pemut 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 infonnation may be shared with other local, state or federal agencies to the extent necessary to <br /> process the pernut or license. <br /> 4. If your renuested pemut 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 /> ! '� /�.f�r,c}�eC. �, T'U G�� � <br /> First Middle Last <br /> � '�✓ � �� R/h��/ .r..�^R�e � <br /> Address <br /> y�,�,�,�,� --� �s�y-� ��� �� .����/ ��a- y��c���� <br /> City Statc Zip Pl�orie <br /> I understand my rights as stated above. <br /> ` / <br /> Signature <br /> �� ' <br />