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Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA <br /> Subd. I. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set fonh in this secdon. <br /> Subd.2. Information reqirired to be given individual. P.n individual asked to supply private or confidenrial data concerning himself shall <br /> be informed of: (a)the purpose and inunded use of the requesred data within the collecting'state agency,polidcal subdivision,or sratewide systnm; <br /> (b)whe[her he may refuse oY is legally required to supply the requested data;(c)any k�own consequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idenary of o[her penons or endaes authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesaeaave dara, punuan[to section 13.82, subdivision 5, to a law enforcemen[officer. <br /> The commissioner of re�enue mav place the noace required under this subdivision in the individual income tax or propertV tax refund <br /> instruccions 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, private or confidendal. Upon his fur[her request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be infoaned of the content <br /> and meaning of rhat data. After an individual has been shown[he 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 pursuanc to this secdon is pending or addidonal data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individuai subject of[he data. The responsible authority <br /> may require the requesting person to pay the actual costs of making, cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immediarely, if possible, with any request made pursuant ro this subdivision,or wi[hin five days of <br /> the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addiaonal five days within which co comply with the request,excluding Saturdays, <br /> Sundays and legal ho(idays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest�he accuracy or completeness of public or private <br /> data conceming himself. To exercise chis right,an individual shall nodfy in writing che responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall wi[hin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipienrs named by the individual; or(b)nodfy the individual thac he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's stacemenc of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible au[hority may be appealed pursuant to the provisions of che administradve procedure act reladng 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 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 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 permit 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 /> � �1,,,2,�,�• ��- S 7,., `�'� T` <br /> First Viiddle � Lasc <br /> S"�ti `� � �.� i�ti .�� � /S � ✓�� <br /> Address �^ SS�� , / / 1 �� _ �S� ��— <br /> �,1^ �ti"v�5� i �" 1 Y `—1 `� <br /> C�ry Stare Zip Phone <br /> I understand my rig ts as sta ed ve. <br /> � <br /> Signaare <br />