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� <br /> s <br /> Sec.13.04 RIGHTS OF SLTB.TECTS OF DATA <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 required to be given individual. An individual asked to supply private or confidential data conceming himself shall <br /> be informed of: (a) the purpose and intended use of the requested data within the collecang'state age�cy, polirical subdivision, or statewide system; <br /> (b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the idendry of other persons or endries authori2ed by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigarive data, pursuan[to seccion 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the notice required under this subdivision in the individual income tac or propertv tax refund <br /> instnicrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whether it is classified as public, private or confidential. 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 without any char;e[o him and, if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of its meaning, the data need not be disc(osed to him for <br /> six months thereafter unless a dispute or acdon pursuant to this section is pending or addidonal data on the 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 authoriry <br /> may require the requesting person to pay the actual cosu of making, cemfying, and compilin�the copies. <br /> The responsible authority 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 Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform rhe individual,and may have an addidonal 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 private <br /> data conceming himself. To exercise this right,an individual shall noafy in writing the responsible authority describing the nature of the disagreemen[. <br /> The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of[he responsible authoriry may be appealed pursuant to the provisions of the adminiscrative procedure act retating 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 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 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 (available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or pemut. <br /> � , } <br /> , {�, <br /> /�; l 'r �i, V� 'I L:;�Z �<�'�'t �:, !`� r� / <br /> First Midd(e Last . <br /> � .�� � � , <br /> /�� / 7 `� �JL?��G��1 � � 12C �`"` <br /> Ad¢�ess ' ` <br /> c , ` �� � .� ."� �>��r�, _� ��:_) � <br /> � �✓%�'� u � �' �, i , <br /> �`. V 1 � �; � ��a l ,�� „� � � <br /> Ciry State Zip Phone <br /> I under�auid my rights as stated above. <br /> � ���- � I ; <br /> T �;:" '';i�;/ !'/� , <br /> Signacure ' �/ � <br /> � <br />