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� 1 <br /> Sec.13.04 RIGH'I'S OF SLJB.TECTS OF DATA <br /> Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or co�dendal data conceming himself shall <br /> be informed of: (a)the purpose and intended use of che requesced data wichin the collecting'state agency, polidcal subdivision,or stacewide system; <br /> (b)whether he may refuse or is le¢ally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply <br /> privace or co�denrial data;and(d)the identiry of other penons or entiries authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked[o supply invesrigadve data, punuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv tax refund <br /> instrucrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,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 confidential. Upon his further request, an individual who is the subjecc <br /> of stored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of its meaning, che data need not be disclosed to him for <br /> six months thereafter unless a dispute or action pursuant to this secaon is pending or addidonal data on the individual has been collected or creaced. <br /> The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry <br /> may require the requesting person to pay the actual cosu of making, certifying, and compiling the copies. <br /> The responsible authority shall comply immediacely, if possible, with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request <br /> within that[ime,he shall so inform the individual,and may have an addidonal five days within which 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 private <br /> data concerrung himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shafl within 30 days either. (a)correc[the data found to be inaccura[e or incomptete and attempt to nodfy past recipien[s of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)nocify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinadon of the responsible authoriry 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 permit 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 pemut 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 cenain 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� �P �t�'z�.��2�7�� <br /> „ ,.,, <br /> First Middle Las[ <br /> .�Z 2 � C�sc..o G� r��.��( - <br /> A��S zr-�i-�� �1E'� S"��i1 �-��I� b �� 1. <br /> C��, Stare Zip Phone <br /> I understand my rights as stated above. <br /> �� , <br /> Signa[ure <br />