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. � <br /> . , <br /> Sec.13.04 RIGHTS OF SLJB.TECTS OF DaTA <br /> Subd. 1. Type of data. The righcs of individual on whom the daa is stored or to be stored shall be as set forrh in this secrion. <br /> Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the requesud data within the collecang state agency,poiiacal subdivision,or statewide system; <br /> (b)whe[her he may refuse oY is legally requi�d to supply[he czquesud data;(c)any known coasequence arising from his supplying or refusiag to supply <br /> private or confidendal data;and(d)rhe idenriry of other persoas or enrides authorized by state or federal!aw to receive the data. This requiremeat shall <br /> noc apply when an individual is asi:ed to supply invesrigadve daca,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer. <br /> llte commissioner of revenue mav olace the noace reouired under chis subdivision in the individual income taz or orooem taz refund <br /> instrucdons ins�ead of on chose forms. <br /> Subd.3. Access to data by individual. Upon request to a respoosible authoRry,an individual shall be informed whether he is the subject ' <br /> of scored data on individuals,and whether it is classified as public,priva�e or confidenaal. Upon his further request, an individual who is the subjecc <br /> of storcd private or public data on individuals shall be shown the dard wi�houc aay charge to him and,'if he desires, shall be informed of the content <br /> and meaning of that data. After an individual h�s been shown[he privace data aad informed of its meaning,the data need not be disclosed to him for <br /> six monchs[hereafter unless a dispuce or acaon pursuant to this secdoa is pending or addiaoaal dara on the individual has been collect�d or created. <br /> The responsible authority shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry <br /> may require the requesdng Qerson to pay the accual cosu of making, certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible,wich any request made pursuant to this subdivision,or wi�hin 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 wirh the request <br /> within that time,he shall so inform che individual,and may have an addiaooai five days wi[hin which to comply with the request,exciuding 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 orprivate <br /> data concerning hirnself. To exercise this righc,an individual shall nodfy in wridng the responsible au[horiry describing the nature of the disagreemenc <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccucace or incomplete and aaempt to nodty past recipienu of <br /> inaccurate or incomplete data, including recipiencs named by[he individual;or(b)aoafy the individua!thac he believes che dara to be correct Data <br /> in dispuce shali be disclosed only if the individual's statemenc of disagreement is included wi[h[he disciosed data. <br /> The determination of the responsible auchoriry may be appealed pursuant to the provisions of the admuvs�adve procedure act relaang to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri�hts 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 de[ermine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the perm.it or license. <br /> 3. The information may be shared wich other 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 information may become <br /> public. <br /> 5. You have certai.n rights under M.S. 13.04 (available upon request) to review private da[a on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> J�� � ,� � <br /> � �12�����L <br /> Firn Middle Lasc <br /> �5 `�S � �i �f'�� <br /> aaa�ss <br /> �-'�� �-�� c�"� /�ti� �1-��/ `��l- 7� Y `-/ � <br /> City — � Stam Zip Phone <br /> I understan rights as st�d ove. <br /> ; `f��G, . <br /> � <br /> � <br /> Signature <br />