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l . <br /> .�- -. . <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be scored shall be as set forth in this secdon. <br /> Subd.2. Iaformation required to be given individual. An individual asked to supply private or confidendal data conceming himself shall <br /> be informed of: (a)the purpose and incended use of[he requested data within the collecring'sta[e agency, poliacal subdivision,or statewide system; <br /> (b)whether he may refuse or is leealiy required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idenary of other persons or enacies authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigadve daca, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv tax refund <br /> instrucdons instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whether ic is classified as public, private or confidential. Upon his further request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown[he data wi[hout any charge to him and, if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of i[s meaning,the data need not be disclosed to him for <br /> six months thereafter uriless a dispute or action pursuant to this secaon is pending or addiaonal data on che individual has been collected or created. <br /> The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requescing person to pay the actual costs of making, certifying, and compiling the copies. <br /> The responsible authority shall comply immediately,if possible, with any request made pursuant to this subdivision, or within five days of <br /> the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addidona(five days within which 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 private <br /> data concerning himself. To exercise this right,an individual shalt notify in writing the responsible authority dzscribing the nature of the disagreement. <br /> The responsible authority shall within 30 days either: (a)correcc ehe data found to be inaccurate or incomplete and attempt to nodfy past recipienu of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is inciuded with the disclosed data. <br /> 1"ne determination of the responsibfe authoriry may be appealed pursuant to the provisions of the administradve procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Riehts of subjects of data", we would like to inform you that your request <br /> for a pernut 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 deternrine 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 pernut or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary to process <br /> the pernut or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> public. <br /> S. 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�tX��'�L� � �� ,�_�_(Th��� � I�. I� !;,_ <br /> First �iid le � Last <br /> �q';�, � C�'�.�.�I(/,� � �- 'J'� � - <br /> Addres —{. — <br /> � � <br /> '� ` .-1tL � ' ' �j_'�)`1 � `�'� �_s. c—;j �-;� <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. 1 <br /> '�� _� \�.�,� �-��1 � �` ,�1� <br /> ,� _ <br /> ��1 <br /> Signature <br />