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f Sec.13.Od RIGHTS OF SUSJECTS OF DATr� Subd. l. Type of data. The rights of individual on whom the data is srored or to be stored shall be as set foRh in this section. SuUd.2. Information required to be given individual. An individual asked to supply private or contidential data conceming himselfshall be informed ofl (a)the purpose and intended use oFtlie requested data within the coliecting state agency,political subdivision,or statewide system;(b) whether he may retLse or is legally required to supply the requested data;(c)any hnown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant[o section 13.82,subdivision�,to a law enforcement officer. The commissioner of revenue mav�lace the notice required under this subdivision in the individual income tax orgro e�rry tax refund instructions instead of on those fonns. 5ubd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contidential. Upon his further request,an individual who is the subjcct of stored private or public data on individuals sitall be shown the data�vithout any charge to him and,if he desires,shall be inFormed of the conten[and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for si� months dlereafter unless a dispute or action pursuant to this section is pendine or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or publ ic data upon request by die individual subject of the data. The responsible aufhority may require the requesting person to pay the actual costs ofmaking,certifying,and compiling the copies. The responsible authority shall comply immediately,if possibie,with any request made pursuant to this subdivision,or wi[hin tive days of the date ofthe request,escluding 5afurdays,Suildays and legal holidays,if immediate coinpliance is not possiUle. [f he cannot comply with the request within that time,he shall so infonn the individual,and may have an additional tive days within which ro comply with the reques[,excluding Saturdays. Sunda��s and legal holidays. 3ubd.4. Procedure when data is not accurate or complece. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this ri�ht,an individual shall notify�in wri[ing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incompiete and attempt to notily�past recipients of inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes the data to be correc[. Data in dispute shall be disclosed only if the individual's s[a[ement of disagreement is included�vith the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a permit or license from the City of Ocono or any of its departments may require you to furnish certain private or confidenti�l information. You are notified that: l. The information you furnish will be used to deteiYnine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernlit or license. 3. The infonnation may be shaced with other local, state or federal agencies to the extent necessary to process the permit or license. �4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain ri�hts under:vI.S. 13.0�4 (available upor,request)to review private data on yourself. 6. Your full name is required to process this application or permit. . � �� •�G� �""�- j �.,'Y� �Y�.✓1 First �4iddlc Last �� ti� �L, Address � �Yc. c.J,�� /'� J��7 / �� Y'�/��JO Cii� Siatc 7_ip Phone I understand m� rights as stated above. , � % �" / �.. _ Signaturc \ Reset Form �?