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Sec.13.04 RIGFiTS OF S[JBJECTS OF D�T� <br /> Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired 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 requested dara within the collecting'state agency,polirical subdivision,or sratewide system; <br /> (b)whethet he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply <br /> private or co�dential data;and(d)the idenciry of ocher persons or enodes authorized by state or federal iaw to receive the data. This requiremen[shall <br /> not apply when an individual is asked to supply invesrieadve dara, pursuan[to secrion 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav place the nodce re4uired under this subdivision in the individual income tax or property tax refund <br /> instructions insread of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsibie authority,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whe[her it is class�ed as public, private or confidendal. Upon his further request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown che data wichout any charge to hun and, if he desires, shall be informed of the content <br /> and meaning of chat data. Afrzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acrion pursuanc to this secrion is pending or addiaonal 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 authority <br /> may require the requesring person to pay the actual costs of making, certifying, and compiling the copies. <br /> The responsible authoriry 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 requesc <br /> within that time,he shail so inform the individual,and may have an addidonal five days within wtuch 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 pri��ate <br /> data concerning himself. To exercise this right,an individual shall nodfy in wriang the responsible aurhoriry describing rhe nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccura[e or incomplete and attempt to norify past recipienu of <br /> inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual thac 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 determinaoon of the responsible authoriry may be appealed pursuant to the provisions of the admuustradve procedure act relating 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 fumish 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 permit. <br /> � l��V:V�n <br /> � ' <br /> First Middle La <br /> � ���-�`1 !/!/1�L�}" �� <br /> Address • <br /> �:ii�t"L � �NI�✓ �3`� � �S Z�-�l Z���U`�� <br /> City State Zip Phone <br /> I understand my rights as stated ab f ve. <br /> `��___ � <br /> `�/' G� __. <br /> Signatuce <br />