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• �, � � <br /> Sec.13.04 RIGH'I'S OF SIIB.TECTS OF D�TA <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 secdon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall <br /> be informed of: (a)the purpose and intended use of the requested dara within the collecting'state a�ency, political subdivision,or statewide system; <br /> (b)whether he may refuse ot is legaliy required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply <br /> private or co�denrial data;and(d)the idenriry of other persons or entiues authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investieadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund <br /> instructions instead of on those forms. <br /> Subd. 3. Access to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his fur[her request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown the data wichout any charge to hun and,"if he desires, shall be informed of the conten[ <br /> and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for <br /> six mon[hs thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on[he individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority <br /> may require the requesring person to pay the actual costs of making, cenifying,and compiling the copies. <br /> The responsib(e authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of <br /> the date of the request,excluding Sa�urdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform[he individual,and may have an addiuonal 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 pri�•ate <br /> data conceming himself. To exercise this rieht,an individual shall noafy in writing the responsible authority describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disa�reement is included with[he disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions of the administra[ive procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri�ts 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 pemut 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 /> $, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (. Your full name is required to process this application or permit. <br /> � ��� I S H- � ��,��11��-.� <br /> First Middle Last <br /> 2r7 I� C�.SC-� 1�� �-� - <br /> Address <br /> ��l�c� Fl)1-1 5 S��) �71 —0 7�' <br /> City State Z�p Phone <br /> I understand m rig�as stated ,ove. <br /> / � / i� <br /> ,.! ,� <br /> Signature <br />