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- <br /> � . <br /> Sec.13.04 RIGHTS OF SU'BJECTS OF DATA <br /> Subd. !. Type of data. "Ihe riehts of individual on whom[he data is stored or to be stored shall be as set focth in this secdon. <br /> Subd.2. Information reqirired to be given individual. ?�n individual asked to supply private or confidenaal data concerning himself shall <br /> be informed of: (a)the purpose and iatended use of the requested dara within the collecdng"state ageacy, poliacal subdivision,or statewide rystem; <br /> (b)whe[her he may refuse oi is legally required to supply the cequested data;(c)any Irnown consequence arising from his supplying or refusing to supply <br /> • private or confidential data;and(d)[he idenriry of other persons or enrides auchorized by state or federal law to receive the data. This requirement shall <br /> noc apply when an individual is asked to supply invesdearive dara, pursuanc ro secdon 13.82, subdivision 5, to a law enforcement o�cer. - <br /> The commissioner of revenue mav pface the nodce reauired under[his subdivision in the individual income tax or propertv tax refund <br /> instrucrions insczad of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject <br /> of scored data on individuals,and whe�her ic is classified as public, priva[e or conFidenaal. Upon his funher request, an individual who is the subject <br /> of stored private or pubtic data on individuals shall be shown the data wichouc any charge to him and, if he desires, shall be informed of the concent <br /> and meaning of that data. Af[er an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acdon pursuant to [his secdon is pending or addirional data on the individual has been collected or creaced. <br /> The responsible authoriry shall provide copies of the private or pubiic data upon requesc by[he individual subjec�of[he data. The responsible authority <br /> may require che requesring person to pay the actual costs of making, certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediacety, if possible, wi�h any request made pursuanc to this subdivision, or wichin five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply wi[h the request <br /> within[hac tune,he shal(so inform che individual,and may have an addirional five days within wluch to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate <br /> data concerning himself. To exercise chis righc,an individual shail nodfy in writing the responsible authority describing the nacure of che disagreemenc. <br /> The responsibte authoriry shall wichin 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt to noafy past recipients of <br /> inaccunte or incomp(ete data, inctuding recipients named by che individual; or(b) notify the individual thac he believes rhe data to be correct. Data <br /> in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The de[erminarion of the responsible au�horiry may be appeated pursuanc to the provisions of che admuusaarive procedure act relaang 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 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 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 ri;hts 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 /> 9�(.. G <br /> First �tiddle Last <br /> _� ///^ <br /> (�' � � f' d <br /> Address / �� , � <br /> ,- , �-, � -DSr <br /> City State Zip Phone <br /> I understand �; as stated ove _ <br /> � <br /> Signacur � <br />