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►. <br /> Sec.13.04 RIGHTS OF SUBJECTS OF D.�.T�1 <br /> Subd. 1. Type of data. 'Ihe neha of individual on whom[he data is stored or to be stored shall be as sec for[h in this secdoo. <br /> Subd.2. Information reqirired to be�ven indicidual. .�n individual asked co supply private or co�denaal data conceming hunself shall <br /> be informed of: (a) the purpose and intended use oi the requested data wichin the collecring'state agency, polirical subdivision, or stacewide rystem; <br /> (b)whe�her he may reruse or is legally required to suoply rhe rquested data:(c)any Irnown consequence arising from his supplying or refusing to supply <br /> priva[e or confidendal data:and(d)the idendry of ocher eersocs or enddes au[horized by state or federal law ro receive the data. This requirement shall <br /> ❑oc apply when an individual is asked to supply invesriganve data. pursuan[to secdon 13.82, subdivision�, �o a law enforcement o�cer. <br /> The commissioner of revenue mav olace �he ^odce r:auired under �his subdivision in Lhe individual income taz or orooem tax retur.d <br /> ins[ruccions instead of on:hose forms. <br /> Subd. 3. Access to data by individual. L'oon reauest to a responsible au[horiry,an individual shall be inlormed whe[her he is[he subject <br /> of s[ored data on individuals,and whe[her i[is classitied as puolic, pnva�e or contidenoal. L'pon his further request, an individual who is the subject <br /> of stored privace or pubfic data on individuals shall be shown tae da[a wichout any charge to him and, if he desires, shall be inYormed of the content <br /> and meaning oi that daca. .-lfter an individual has been shown[he pnvace data and inrormed of iu meaning, the data need not be disclosed to him for <br /> six months chereatter uriless a dispu[e or acdon pursuanc�o chis secnon is pending or addidooal data on the individual has been collected or crea[ed. <br /> The responsible au�hority shall provide copies of[he pri�a�or pubtic data upon request by rhe individual subject oi the data. The responsible auchorirv <br /> may require the requesnng penon to pay che acmal costs o[making, cer�ryin2, and compiling the copies. <br /> The responsible authoricy shall comply immedia[ely, if possible, with any request made pursuant to this subdivision, or wi[hin five days of <br /> the date of che request, excluding Sa[urdays,Sundays and lezal holidays,if immediate compliance is noc possible. If he canno[compty with the request <br /> wi[hin tha[time,he shall so iniorm[he individuat,and may have an addidonal five days within which to comply winc�he request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeoess of public or private <br /> data concemine himseif. To exercise this riehc,an individual shall nodfy in wndng the responsible au[honry describing the nature of the disagreemenc. <br /> The responsibie au�horiry shall within 30 days eicher: (a)correct the data found to be inaccura�e or incomplete and attempt to nodfy past recipiencs of <br /> inaccura[e or incomple[e data, includine recipien�s named by [he individual; or(b) notify the individual that he believes the dara to be correct. Data <br /> in dispute shall be disclosed only if the individual's sta[Pment of disaereement is included with tf�e disclosed data. <br /> The determinanon of the responsible authority may be appealed pursuan�ro the provisions of the administrauve procedure ac[ reladn2 [o <br /> contested cases. <br /> DAT:� PRIVACY :�DVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Righ[s 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 ��ny of its departments may require you to furnish cenain private or <br /> confidential information. <br /> `i ou are :ocified chat: <br /> 1. The information you fumish will be used ro determine 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 permit or license. <br /> ;. The information may be shared wich o�her local, state or federal aaencies 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 /> (. Your fuil name is required to process this applica[ion or permit. <br /> �i�9-�f� �5 /�.�/9-� i� ��-�i��'� <br /> First �fiddle Last <br /> �-����, �x c �L Si r�.P ��� �� <br /> Addre� � ��UC, 1 S �� ����� � J ��� ,��� 3��CU�� <br /> J <br /> Ciry State Z:p Phone <br /> I understand my rigbts as st� above. <br /> � �-�---�.�- ���y'� <br /> Signacure <br />