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Sec.13.0,1 RIGI3TS OF SUBJECTS OF DaTa <br /> Subd. (. Tvpe of data. "Ihe righcs oi i�dividual on whoci[he data is s:or_d or m be scor:.d shall be as sec forrh ia chis section. <br /> Subd.2. Informaaon reqirired to be�vea individual. ?.n individual uked w suppiy private or conr.dendal daa coacerning himself shalI <br /> be informed of: (a)�e purpose and iaL.aded use of�he requencd daca wichin�e:ollecdn3 3ar-ageary,polidcal subdivisioa,or scimwide rystm; <br /> �b)whe:her he may r.fuse or is le3a[ly cequited w si:pply ehe requesud dati:(c)acy Icown coasr�uence arisin3 from his supplvi.^.g or refusing m suoply <br /> privar.or confidendal dara:and(d)che idaadty oi or*erpersons or enddas au�horiz�by sca[_or fad�ral law to rceive[he da�a. This requiremen�shall <br /> noc app[y wFan an individuai is asked to s�pply ia�•esaeadve daa,pursuanc ro sec�oa 13.82, subdivision 5, [o a law enfocze^�ac o�eer. <br /> The commissioner of rve�ue mav olac_ the noace reauired under �his subdivision in the ir,dividuai income ct:c or orooem mz refur.d <br /> inscrucuons ins�ead of on�hose forms. <br /> Subd.3. access to data b�indiridual. tipon reques[to a responsiblt auchoriry,aa individual shall be infocmed wh.erher he is the subject <br /> of scored dact on individuals,and whe:�er ic is d�ssifed as public, privace or con:de^dal. L'poa h-is fur�er rertuest,an individual who is the subjecc <br /> of scorrd privace or public daci on indir-iduals shall be show-n che daca wichouc any caar3e tD hia and:if he desires, shall be iaiorczed of[he concer.c <br /> ar.d meaning oi chat dac�. Aher an individua!hu 6ecn shown che privam dara and iaiormed oi iu meaning,the data need aoc be disclosed w him for <br /> six monctu �her_aiti:r unless a dispute or acrion pucsuanc[o chis secdon is pend�.g or addidoa�l dara on che individual has beea coUected or creared. <br /> Tne responsibia au�hociry shall providz copies ot�he privace or Qu61ic daea upon r_Yu:sc by[he individual subjecc of cl:e daci. Tne responsible au�horiry <br /> may r:quire che requesring person ro pay che acn:al cosu of malcinc.certifying,ar.d compiIing the copies. <br /> Tne r_sponsible auchoriry shall comply ir.ur:ediate(y, if possible, wirh�:.y:�qu�st�d�PutSuant co[his subdivision,or wichin five d�ys oi <br /> the dace of che requesc,e�cluding Sacurdays.Sur,days and legsl holidays,if immedu::compliacce is not possible. If he cannoc comply wich the requesc <br /> Wl4tl1l1 d13[QIIIC,he shall so inform che individual,u:d may have an addidonal five days wichin which�o comply wica�he request,excluding Saturdays. <br /> 5undays and 1eg31 holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An ir.div;Cual may concest[he accuracy or completeaess of public or pri�•a[e ' <br /> daci cor.ceming himself. To exer.ise�is righc,an individual shall noafy in wri�g:�:rspoasiole aurhoriry describing�he nan::e OL�le d153gltemeac. . <br /> 'Ihe responsible au�horiry 5ha11 wichin 30 days ei�`.er: (a)correcc�he da�a found ro:�inaccc�c_or ir.complem and aaempc co nod,`y past tecipiencs of <br /> inaccum:o or incomple:e dars, including recipienc�named by [he individual:or(b)�orify ch: i�dividual chac he believes the dara to be coctzec Dac� <br /> in dispuce sh�ll be disc!osed only if[he individu�l's sa�emenc of disagreemenc is i^:tuded wiL`�che disclos:d dac3. <br /> 'Ihe dece:minadon of cha rtsponsiol� auchoriry may be appealed purn:��:ro the provisions of tha admuusaarive pro.edure act reladag co <br /> concesrd cases. <br /> DAT?� PRIVACY :�D`'ISORY <br /> In accordance with�1.5. 13.04, Subd.2, "Righ[s of subjecu oi data", w�e would like to inform you tha[your reauesc <br /> for a permit or license from the Ciry ot Orono or any of ics depz�.ments may require you to fumis� certain private or <br /> confiden�ial information. <br /> You are notified that: <br /> 1. The information you fi:rnisa will be used to determir.�your quzliLication for che permit or license requested. <br /> ? You may refuse to supply daca, buc refusal may reeuire thzt che Ciry deny the permi� or license. <br /> ;. The informacioa may be shared with ocher local, stat�or federal a�encies co the extent necessary to process <br /> the permit or license. <br /> .}. If your requested permit or licease requires Council action to approve, some informacion may become <br /> public. <br /> �. You have cercain riQhcs under �1.S. 13.04 (availabl� upon request) to review private data on yourself. <br /> 6, Your full name is required to process chis applica�:oa or pe:mic. <br /> � � �f , �— <br /> z �=( �a <br /> First �ti dlz Last <br /> ��g w�`C �� <br /> �iddrss � <br /> w� � �-c%l �S 3 ��', ��Z i{7 tj—i l z 3 � <br /> Ciry Sa� Zip Phone <br /> �-_. <br /> I under d my ri�hts as stared ao�e. <br /> ' <br /> _� <br /> � <br /> � <br /> Signacure ' <br />