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'�"1 <br /> � <br /> Sec.13.04 RIGHTS OF SLB.TECTS OF D�T� <br /> Subd. 1. Type of data. The nehts oi individual on whom che data is scored or[o be stored shall be as sec forth in this secdon. <br /> Subd.�. Information required to be�ven indi�idual. �n individual asked to supply private or confidenaal daci conceming himself shall <br /> be inYormed of: (a) the purpose and in[ended use of the requested da[a wi[hin the collecdng'state aeency, pollrical subdivision, or sta[ewide system; <br /> (b)whether he ma}•refuse or is legally required to supply che c�quested data;(c)any Irnown consequence arising from his supplying or refusing to supply <br /> priva�e or confidenaal data:and(d)the idendty of o�her persoos or enndes au[horized by state or federal law ro receive the data. This requirement shall <br /> no[apply when an individual is asked to supply invesngadve data, pursuant to secnon 13.82, subdivisioa�, to a law enforcement ofitcer. <br /> The com.missioner of reverue �nav olac� �� odce ��ouired under this �ubdivision in the individual income raz or propem tat reiund <br /> instructions inscead ot on[hose forms. <br /> Subd. 3. Access to data by indi��dual. [Ioon reques[to a responsible auehonry,an individuai shall be informed whether he is the subjecc <br /> of stored data on individuals, and whether ic is classined as public, pnvace or contidennal. lipon his fur[her request, an individual who is the subjec[ <br /> of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desites, shall be informed of the content <br /> and meaning of that data. Afrer 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[herearrer unless a dispute or acdon pursuane[o this secdon is pending or addi[iooal data on[he individual has been collecced or crea[ed. <br /> The responsible aucnoriry shall provide copies of the pn�ace or public data upon request by the individual subject oi the data. T'he responsible authoriry <br /> may require [he reauesting pecson ro pay [he acrual cosu of making, certifyine, and compiling the copies. <br /> The responsible authori[y shall comply imm�iacely, if possible, wi[h any requesc made pursuant to this subdivision, or wi[hin five days of <br /> the date of the reques[,excluding Sa[urdays.Sundays and leeal holidays, if immediate compliance is no[possible. If he cannoc comply with the request <br /> within that time,he shall so intorm[he individual,and may have an addidonal five days wi�hin which ro comply with the request,exciuding Sacurdays, <br /> Sundays and (eeal holidays. <br /> Subd. 4. Procedure when data is not accurate or complete. An individual may concest che accuracy or completeness of public or priva[e <br /> data concerning himself. To exercise�his right,an individual shall notify in wricing the responsible au�horicy describing the na[ure of the disagreemen[. <br /> The responsible auchority shail wichin 30 days ei[her: (a)correct the data found ro be inaccura[e or incomplete and attemot to nodfy past recipients of <br /> inaccurate or incomplete data, inciudine recipients named by the individual; or(b) nodfy ehe individual tha�he believes the data to be correc[. Data <br /> in dispu[e shall be disclosed only if the individual's stacemen[of disaereement is included wich the disclosed data. <br /> Thz decermina[ion of[he responsible au[honcy may be appealed pursuan[ro [he provisions of the admuustradve procedure ac[ rela[ing to <br /> contested cases. <br /> DAT:� PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Righcs of subjects of data", we would like to inTorm you that your request <br /> for a permit or license from che City of Orono or any of its departments may require you to fumish certain private or <br /> � confidential intorma[ion. <br /> `i ou are aotified tha[: <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 da[a, but refusal may require [hat the City deny the permit or license. <br /> 3. The informacion may be shared wi�h o�her local, state or federal asencies 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 cercain rights under �1.S. 13.04 (available uoon request) to review private data on yourself. <br /> (. Your full name is required to process this application or permit. <br /> �/J��E. �' U�K-%� �C/C��C�t � <br /> First ��d'�� Last <br /> �,� c� c: ��(r` f=G S�u/� �/ U �� - <br /> Address <br /> �r'� �U i S �l� �C7,C/ 53��/� ;�L � �'�� <br /> Ciry Sta�e Z:p Phone <br /> I unde d my rights as stated above.�_ <br /> /� � <br /> � ��_S��__: <br /> Si ature <br />