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Sc�13,04 RIGNTS OT5UBJECTS OF D.ATA <br /> Subd.1. Type of data. The righls of individual on whom thc dah is sto�d or to 6c stored shall be as set forth in this sce�ion_ <br /> Subd.2, Informa�ionrequiredtobegivenindividual..qnindiviclualas[cedtosupp[yprivateorcanfidentialdataconceminghimselfshallbe <br /> informed of: (a)the purpose and intended use of the�qucs[ed daGi within the collecting slate agenc.y,po�itical s¢bdivision,or statewide system;�b) <br /> whether he may refuse or is lega(!y rcquired to supply the requested dula;(c)any known consequE;nee arising Gom his supplying or refusing to supply <br /> pnvale or confidential data;and(d)Ihe identity otother petsons orentities authorized by state or fzderal]aw lo raceive 1he deta This requirernenE shall <br /> not apply�vhen an individual is asked to supply investigative data,pur5uant to section 13.&2,subdivision 5,to a law enforcement olTicer, <br /> The commissioner of revenue rnav ol�ce�he notice renui�ed under this subdivi ion in the individual mcom tax or orone [�x refund <br /> �nstr¢ctions io��ad of on Ihose forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individuaf shall be informed whether he is the subiect oC <br /> stored dala on individuals,and whether i1 isclassified as public,ptn•ateor confidential. Upon his funher requesl,an individual who isthe subjec[oF <br /> stored private or public daCa on individuals shal I be shown tbe dah without any charge to him and,if he desi res,shall be informed of theconlent and <br /> meaning of that da1a. Af1er an indi��idua]has been shown the private data and informed oFits meaning,!he dala need not be disclosed lo him for six <br /> monlhs thereafier unless a dispute oraction pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> responsible sulhority shal[provide copies of thc private or public dala upon request by the individual subject of the data. '1'he responsible authority <br /> may require the requesting person to pay[he actual costs of making certifying,and compiling Uie copics. <br /> The respoasi b[e authority shall comply imrnaQiate[y,iCpossible,witfi any requesl made pursuant to this subdi��ision,orwith in five days of <br /> [he date ofihe reques[,axcluding$aturdays,Sunda}�s and fegal hol�days,if immediate compliance is not possible. {t"he cannotcomply with the requesl <br /> wi th in that time,he shall so inform the individual,and may have an additional fi��e days�ti•ithin which to comply with che reques[,zxcluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd,4. Proeedure when data is notaccucate orcomplele.An individual may contest the accuracy orcompleteness of public or privaze dala <br /> concerning E�imself. To exercise this right,an individual shall notify in writing theresponsible authoriry describing the namre of the disagreement. The <br /> responsible uuthority shall wititin 30 days either: (a)correct ihe data 1'ound ro be ineccurate or incomplele and attempt io notify past recipients of <br /> inaccurabe or inoomplele data,including recipienls named by the individual;or(b)notify the individual t[iat he believes the data to be comxt. Datain <br /> dispu[e shall be disclosed only if the individual's stacement oFdisagreement is included wilh the disclosed data. <br /> The delermination oCihe responsible authoriry may be appealed pu�suant to lhe provisions oFthe administrative procedure act relatins 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�nform you lhat your request <br /> for a pern�it or license from the City of Orono or any of its depariments may require you to furnish certain private or <br /> confidential information. <br /> You are noti[ied tha�; <br /> 1. The information you fumish will be used to determine your quali6cation for the permit or license <br /> requested. <br /> 2. You may refuse lo supply data, but refusa!may require lhat the City deny the permit or lieense. <br /> 3. The information ma}� be sharcd with other local,state or federal agencies to the extent necessary to <br /> ptocess the permit or license. <br /> 4. lf your requested permit or license requires Council action to approve,some information may become <br /> pob[ic. <br /> 5. You have certain rights under M.S. 13.04(available upon requcst)to revicw private data on yourself. <br /> b. Your full name is required to process this application or permit. <br /> Fitst Middle <br /> ,(�/� � � Last <br /> 1 `t \ �C( r��1 �C�f' <br /> 4ddress <br /> \O V �. 2'� rcl� � }�,b ,�,MI' J �� ���Z� �1�— / �/ l ��� <br /> L�'�7 � Y <br /> Ci[y <br /> Stxtc Zip Phone <br /> i understaa y r' ts as s t d ab ve. <br /> 5i�nature ��((�� <br /> 33 <br /> b'd 10��-OSti-�99 ae�na�{ �aeW e9L��6 80 E6 a�W <br />