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� � y J • <br /> Sec.13.04 RIGHTS OF SLJB,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 secaon. ' <br /> Subd.2. Inforination required to be given individual. An individual asked to supply private or co�dendal data concerning himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecdng state agency,poliacal subdivision,or statewide <br /> system;(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or <br /> refusing to supply private or confidenual daa;and(d)the idenriry of other persons or entiaes authorized by srate or federal law to receive the data. <br /> This requirement shall not apply whzn an individual is asked to supply investigative data, pursuant to section 13.82, subciivision 5, to a law <br /> enforcement officer. <br /> "Il�e commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or nro�ertv tax refund <br /> instrucrions mstead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the <br /> subject of s[ored data on individuals,and whether it is classified as public,private or confidenrial. Upon his further request,an individual who <br /> is the subject of stored priva[e or public data on individuals shall be shown the data without any char;e to him and, if he desires, shall be informed <br /> of the content and meaning of that data. After an individual has been shown�4e private data and informed of its meaning, the data need not be <br /> disclosed to him for six months thereafcer urless a dispute or acaon pursuant to this secaon is pending or addirional data on the individual has been <br /> collected or crea�ed. The responsible authoriry shall provide copies of the private or public data upon request by the individua]subject of the data. <br /> The responsible authoriry may require the requesring person to pay the actual cosu of making,certifying,and compiling the copies. <br /> Tl�e resporuible authority shall comply immediacely,if possible,with any request made pursuant to this subdivision, or within five days <br /> of the dace of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> the request wi[hin that time, he shall so inform thz individual, and may have an addirional five days within which to comply with the request, <br /> excludin�Saturdays,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 <br /> private dara conceming himself. To exercise this right,an individual shall nocify in writing the responsible authoriry describing the nature of the <br /> disagreement. The responsib(e authority shall within 30 days either: (a)correct the data found to be inaccunte or incomplete and attempt to nocify <br /> past recipiencs of inaccurate or incomplete dara,including recipients named by the individual;or(b)noafy the individual that he believes the data <br /> [o be correct. Data in dispute shall be disclosed oniy if the individual's statement of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisnaave procedure act relating <br /> to 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 <br /> request for a permit or license from the City of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license <br /> 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 <br /> process the permit or license. <br /> 4. If your requested pernut 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 permit. <br /> � �.J f(� �\'G� �;� <br /> F�rst iddle � <br /> Z�� J �C`��C� g� �� Last <br /> Address <br /> �".���v�.a 1'l�1 N ��5� �� %SZ- `��T�- �Ga�' <br /> C�ry Srate Zip Phone <br /> I understand mv ri ts as sta . <br /> � . <br /> Signature <br /> 6 <br />