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� <br /> Sec.13.04 RIGH'I'S OF SUBJECTS OF DATA , <br /> Subd. i. Tvpe of data. 'I�e righcs of individual on whom rhe data is stored or co be stored shall be as set fonh in this secdon. <br /> Subd.2. Iaformation reqirired to be givea individual. P.n individual asked to supply private or confidenaal data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the requesced data wi[hin the collecdng'state agency, polidcal subdivision,or sratewide system; <br /> (b)whe�her he may refuse or is le¢ally required to supply the requested data:(c)any imown consequence arising from his supplying or refusing to suppty <br /> private or contidendal data:and(d)the idendry of other persons or entities auchorized by state or federal law to receive the data. This requirement shall ,� <br /> not apply when an individual is asked [o supply invesrigaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcemen�o�cer. <br /> The commissioner of revenue mav vlace the nodce re uired under this subdivision in the individual income rax or rooem rax re"r.i^.d <br /> instrucrions instead ot on those forms. <br /> Subd. 3. �.ccess to data by individual. Upon request to a responsible authoriry,an individual shall be informed whecher he is[he subject <br /> of stored dara on individuals, and whether it is classiried as public, private or confidendal. Upon his futther request,an individual who is the subject <br /> of stored priva[e or public data on individuals shall be shown[he data wichout any charge to him and, if he desires, shall be infoaned of the content <br /> and meaning of[ha[data. After an individual has been shown[he private data and informed of i[s meaning, [he data need not be disclosed to him tor <br /> six monchs chereafrer uriless a dispute or action pursuant to this secdon is pending or additional data on the individual has been collected or creaced. <br /> The responsible authoriry shali provide copies of the priva[e or public data upon reques[by the individual subjecc oi the dara. The responsibte au[horiry <br /> may require the requesting person co pay the actual costs of making, certifying, and compiling the copies. <br /> The responsible authoriry shall comply immediarely, if possible, with any request made pursuant to this subdivision,or wichin five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibfe. If he cannot comply wi�h�he reaues� <br /> within that time,he shall so inform[he individual,and may have an addiaonal five days within which to comply wi�h the reques[,excluding Sacurdays, <br /> Sundays and legal holidays. <br /> Subd.�l. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or priva[e <br /> data concerning himself. To exercise�his right,an individual shail nocify in writing the responsible authoriry describing the nature of the disagreemen[. <br /> The responsible auchonry shall within 30 days either. (a)correcc[he data found to be inaccura[e or incomplete and attempt to nodfy past recipiencs of <br /> inaccurate or incomplete data, including recipien[s named by [he individual; or(b) noufy the individual chat he believes[he data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed dara. <br /> The detzrmination of the responsible au�horiry may be appealed pursuant to the provisions of the adminisuaave procedure act relaang to <br /> con[es[ed 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 privace 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 /> Z, You may refuse to supply data, but refusal may require that the City deny the pernut or license. <br /> 3, The information may be shared with other loeal, scate or federal agencies to [he extent necessary to process <br /> the permit or license. <br /> 4. If your requested pernut or license requires Council action to approve, some information may become <br /> public. <br /> �. You have certain rights under M.S. 13.04 (available upon request) to review private daca on yourself. <br /> (. Your fu11 name is required to process this application or permit. <br /> , <br /> �i / <br /> � '� ;:'�'� t /� �_ �` ''I%��C� <br /> � S�( <br /> F.�� tifiddle �.ast <br /> � / ,,f <br /> i �7�,'L.% L'l / / <br /> A dress � �1 �-�� / � � � /,i/���---�(�� <br /> /i,' , �j�,��f / � ,. <br /> ',� ' "�l��� Phone <br /> Ciry State ZlP <br /> I understan my rights as stated above. <br /> � <br /> ,, � <br /> � <br /> `� � C ic /-� ���� �'�� �/�� <br /> Signamre " , <br /> � <br />