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: . . <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type 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 required to be given individual. An individual asked to supply private or confidential data concerning himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide <br /> system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or <br /> refusing to supply private or confidenaal dara;and(d)the idenriry of other persons or endries authorized by state or federal law to receive the data. <br /> This requiremenc shall not apply when an individual is asked to supply invesdearive data, pursuant to section 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav olace the noRce reauired under this subdivision in the individual income tax or orooertv tax refund <br /> instructions instzad of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsiblz authoriry,an individual shall be informed whether he is the <br /> subject of stored data on individuais,and whether it is classified as public,private or confidential. Upon his further request,an individual who <br /> is the subject of stored private or public data on individuals shall be shown the data wzthout any charge to him and, if he desires, shall be infocmed <br /> of the content and meanin,of that data. After an individual has been shown the private data and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafrer unless a dispute or action pursuant to this secaon is pending or additional data on the individual has been <br /> collected or created. The responsibte authority shall provide copies of the private or public data upon request by the individual subject of the data. <br /> The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. <br /> The responsible authoriry sha(I comply irnmediately,if possible,with any request made pursuant to this subdivision, or within five days <br /> of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wich <br /> the request within that time, he shall so inform the individual,and may have an additional five days within which to comply with the request, <br /> excluding Saturdays, 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 <br /> private data conceming himself. To exercise this rieht,an individual shall notify in writing the responsible authoriry describing the nature of the <br /> disagreement. The responsible authoriry shall within 30 days either. (a)coaect the dara found to be inaccurate or incomplete and attemp[to notify <br /> past recipiencs of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determu�auon of the responsible authoriry may be appealed pursuan[to the provisions of the administrative procedure act relating <br /> to 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 <br /> request for a permit or license from the City of Orono or any of its departments may require you to furnish certain <br /> private or 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 <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 information may be shared with other local, state or federal agencies to the extent necessary to <br /> process 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 /> �Q-�o c� 7 w � L l.�./�v�� � � t.J iJ �1-m � ��� <br /> First hiiddle Last <br /> �I�.� �C� �1 L Z D �J �?__v l�7 ��-a�-�— <br /> Address <br /> ���,� 1/LL.O'�.�_� /��"��� /J 1,� �S '������ „j � / '� �%/ � Z <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> - , <br /> � ��� � �i�' �:���c�e �'�t ��-�_ - <br /> Signature � <br /> 6 <br />