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� <br /> � <br /> Sec.13.04 RIGHTS OF SLTBJECTS OF DaT?, <br /> Subd. 1. Type of daca. The ri¢hrs of individual on whom[he data is stored or to bz scored shall be as set forch in this secaon. <br /> Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidendal dara concerning himself shall <br /> be informed of: (a)the purpose aad incended use of the reques.ed dara within the collzcang"stace agency, polidcal subdivision,oc sratewide rysum: <br /> (b)whe�her he may refuse or is legally required[o supply the requested da[a;(c)any Irnown coasequence arising from his supplying or refusing to supply <br /> • private or confidendal dam;and(d)[he idendcy of ocher persoas or enaaes auchorized by state or fzderal law to receive the data. This requiremenc shall <br /> not apply when an individual is asked ro supply invesriearive dara, pursuanc ro secdon 13.82, subdivision 5, to a law enforcement o�cer. - <br /> 'Ihe commission r of revenue mav pla-e �h� noac� r�auired under[his subdivision in the individual ir.come tax or prov�m taz refund <br /> insrrucrions instead of on rhose forms. <br /> Subd. 3. Access to data by indi�ldual. Upon reques�to a responsibie au[horiry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whecher ic is class�ed as public, priva�e or confidendal. Upon his furrher request, an individual who is the subjecc <br /> of stored private or public data on individuals shall be shown�2:e daca wi�houc any charge to him and;if he desires, shall be infocmed of the contenc <br /> and meaning of chat data. Afcer an individual has been shown the priva[�data and informed of its meaning, [he dara need noe be disclosed to tum for <br /> six monrhs chereatcer unless a dispute or acdon pursuant to chis secrion is pending or addirional data on the individual has been co(lecced or created. <br /> The responsible authoriry shall provide copies of the privace or public daca upon requesc by the individual subjecc of the dara. The responsible authoriry <br /> may require[he requesring per5on to pay the accua]costs of making,cerafying, and compiling the copies. <br /> The responsible au�horiry shall comply immediately, if possible, wich any request made pursuant to this subdivision, or within five days of <br /> the date of�he request,excluding Sacurdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannoc comply with the request <br /> within tttat time,he shall so inform rhe individual,and may have an addirional 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 compleceness of public or pri�•ate <br /> dara concerning himself. To exercise�his righc,an individual shall noa"ry in wridng che responsible auchoriry describing the nanire of the disagreemenc. <br /> The responsible authoriry shall within 30 days eirher: (a)corrcc the data found to be inaccurace or incomple�e and attemp�to noafy pasc recipients of <br /> inaccunte or incomplete data, including recipien�s named by che individual; or(b)notify che individual that he believes the data to be correct. Data <br /> in dispute shalt be disclosed only if the individual's sc�temenc of disagreement is included with the disctosed dara. <br /> The decerminarion of che responsible auchoriry may be appealed pursuant to the provisions of�he admiruscrarive procedure act relacing to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "RiQhts of subjects of data", we would like to inform you that your request <br /> for a permit or license from the Ciry 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 permi[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 ocher local, state or federal a�encies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some informa[ion may become <br /> public. <br /> 5. You have certain ri;hts 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 /> -�� ; ,� Il���.c ��� � �- ��/����� �� <br /> First �tiddl Last <br /> ����� ����1� /� ��"_/�r� � — <br /> Address ' / . <br /> / /�� -/I ��L� �'�` v v L ������� '� 7 � L <br /> City Snte Zip Phone <br /> I understand my ri�hts as stated above. <br /> I <br /> l �V 'l 1.,� �l�� `� U C-c! �� <br /> Signa�ure <br />