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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�tored shall be as set forth in this sectlon. <br /> Sabd.2. Information required to be given iodividual. An ind[eidual asked to supply prtvate or confide ztlel data concerning 6imselt shall be <br /> informed of: (a}the purpose a�d tntended use of the requested dsta rvithin the eollecting state agency,pol[tical �ubdlvision,or state»�i�e eystem;jb} <br /> whether he may retuse or Is fegalfy required to supply tBe requested data;(c)any known wnsequence arising(roin his supptying or retusing to supply <br /> private or conf[dential data;and(d)the tdenttty of other persons or entitics authorized hy state or federal law to re�;efve ttse datu. This requirement shall <br /> not appfy when ao individual is asked to supply im•estigatfve dsta,pursuant to section 13.82,subdivision S,to a Iaw enforcement officer. <br /> The commissioner of revenue mnv nlace the notice reauired under thia subdivlsion in the ln�divid���ncome tux or urooerlv t�x refund <br /> fnstructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsibie autfiority,an individual shall be inforined whether he is che subject of <br /> stored data on individuais,and whether it is classified as public,private or confidential. tipon his further request,an 1n8ividuai who is the subject af <br /> stored private or publtc datn on indivfduals shaA be ahown the duta without any charge to him and,if he desires,shall be informed of the content and <br /> meaning ot that data. After an indivEdusl has been sho�vn thc private data and informed of its mean(ag,the dAts.aeed not be disclosed to him!or six <br /> months thereafter urtless a dtspute or actton pursuant to this section is pending or add[tional data on the individu;it has been collected or created. The <br /> responsible anthorlty ahail provlde copEes of the private or publlc data upon request by the individual subject of the data. The responsible autHority muy <br /> requtre the requesting person to pay the actual costs of making,certifying,snd compSling the copies. <br /> The responsible authorlty shall comply immediatefy,if possible,with any request made pursuant to this:�ubdivision,or withtn Cve days of the <br /> date of the requcst,excluding Saturdays,Sunduys and legal hol[days,if tmmediate compliance is not possible.If he i:annot comply with the request within <br /> that Nme,he sha11 so inform the indiv'rdual,and may heve an additional[ive days within which to comply with the rcquest,excluding Saturdays,Sundays <br /> snd legal holidays. <br /> ' Subd.4. Procedure when data is not accurate or complete. An indiv,iduat may contest the accuracy or cnmpleteness of pablic or private datu <br /> concerning himself. To ezerclse this right,an fndividuul shail nohfy in wrlting the responsible autdority descrlbing the natu re ot the disagreement. The <br /> responsible aathority sbai!within 30 days either: (a)correct the data found to be Inaccurate vr incomplece and uftempt to noti[y past reciptents of <br /> inaccurate or incomplete d�ta,incl.udir�g recfpients named by the individual;or(b)notify the individual that he be.ieves the data to be correct. Dsta En <br /> dlspute shall be disclosed only if the indivtdual's statement of disagreement is�lncluded w[th the disclosed dsta. <br /> The determinution of the responsible authority muy bc appealed pursuant to the provisions o[the adrrinistrative procedurc act relating to <br /> contested cuses. <br /> DATA PRIVACY A.DVISORY <br /> In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to infarm you that your requesE <br /> for a permit or ticense from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidential informatian. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualification for tt�e permit or license requested. <br /> 2. You may refuse to supply data,bnt refusal may requ'rre that the City deny ttie permit or license. <br /> 3. The information may be shared with other local,state or federat agencies to tt e extent necessary to process <br /> 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(avaiiable upon request) ta review private data on yourself. <br /> 6. Your tull name is required to process this app!'rcation or permit. <br /> '�1'rL-�'�� --� � ��v <br /> First Middlc Last <br /> �'��$' �.1}�c r> ""r�—. ��- _ <br /> Address <br /> l��i'�1'�,s�T�}-- �2� • �'�71 �7�5��"'�7!"Gd! f� <br /> City Stste Z[p Phone <br /> I understa ' hts as stated above. <br /> Signature <br />