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4 <br /> . Sec.13.04 RIGHTS OF SLTBJECTS OE'DaTl� ' <br /> Subd. 1. Type of data. The righ�s of individual on whom che data is stoccd or to bc storrd shall be as set forch ia[his secaon. <br /> Subd.2. Information req�rired to be given indiridual. An individual asked to supply private at confidendal data concerning himsetf shall <br /> be inform:d of: (a)che purpose and iattnded use of[he requuted dam wichia the collecang State agency,polidca!subdivision,or sntewide rysum: <br /> (b)whed:ec he may refuse or is_legally requird to supply che rsquesud data;(c)any 1¢iown coascquence arising from his supplying or refusing to supply <br /> privace or conndenaa!data;and(d)the idenary of o�her persons or enriaes authorized by sc�ce or federa!taw to ceceive che data. 'Ihis requiremenc shall <br /> not apply when an individual is asked to supply iavcsdgaave daa,pursuanc to secdon 13.82,subdivision 5, w a Iaw enforcemeat o�cer. <br /> 'iTu ce;�missioner of revenue mav oface the nodce r.auired und:r chis subdivision in the individual income caz or oropem raz refund <br /> instrucrions instead of on[hose forms. <br /> Subd. 3. Access to data by individual. Upon requesc to a responsible auchoriry,an individual shall be informed whzcher he is the subject <br /> of scored dacs on individuals,and whe[her it is classified as public, priva[e or confidenaal. Upoa his further tequost,an individual who is the subjecc <br /> of stored private or public daa on individuals shall be shovm[he data wichout any charge to hira and,'if ha dzsires, shalI be informed of the content <br /> and meaning of that dara. After an individual has been shown[he privace dan and informed of ics meaning,che dara ne:d not be disclosed ro hun for <br /> six monchs thereafter unless a dispute or acaon pursuanc to this secdon is pending or addidonal dara on[he individual has been collecced or crea�d. <br /> The responsible authoriry shall providt copies of the private or public data upon tequest by the individua!subjeu of[he data. The responsible authoriry <br /> may require [he requesang person to pay the accual cosu of making,certifying,and compiling che copics. <br /> 'Ihe responsible authoriry shall comply immediately, if possible, wich any requesc made punuant to this subdivision,oc wichin five days of <br /> the dace of che request,ezctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot compty with the request <br /> wichin rhac dme,he shall so inform the individual,and may have an addidoaal five days wi[hin which to comply wich the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may con�est[ha accuracy or completeness of public or priva[e <br /> data conceming himself. To exercise this right,an individuai shall noafy in wriring the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shalt within 30 days ei�:er: (a)correct[ha data found to be inaccurdte or incomptece and aaempc to nodfy past recipien�s of <br /> inaccurate or incompiece data, including recipiencs named by che individual; or(b)noafy the individual thac he believes rhe data to be correct. Data <br /> in dispuce shall be disclosed orily if the individual's statemenc of disagreement is included with the disclosed data. <br /> The deceaninadon of the responsible authoriry may be appealed pursuant to the provisions of che adminisaarive procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Righcs of subjec[s 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 determi.ne your qualification for[he permit or license requested. <br /> 2. You may refuse to supply daca, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared wich other local, state or federal a;encies to the eLcent necessary to process <br /> the permit or license. <br /> 4. If your requested perm.it or license requires Council action to approve, some information may become <br /> public. <br /> 5. You have certain ri�hts 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 /> ��� �i e� e v^1 c. � ( -7�}-� ' �-c, � <br /> Fitst �fiddlt Las� <br /> �S3 ..i,��n1 �-�c�� � N �- - <br /> Address <br /> �''l e� �� c� �/�'�/� �5 3� � � 7'2 a-��� <br /> Ciry Sace Zip Phone <br /> I understand my ri;hts as stated above. <br /> r <br /> f <br /> Signa[ure <br />