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._ ' ' <br /> Sec.13.04 RIGHTS OF SUB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Infocmation required to be given individual. An individual asked ro supply private or confidendal data concerning himself <br /> shall be informed of: (a)che purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or stacewide <br /> rystem;(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or <br /> refusing co supply private or confidendal dara;and(d)the idenrity of other persons or endaes aurhorized by srate or federal law to receive the data. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pur5uant to secdon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav olace the norice reauired under this subdivision in the individual income taz or orooerrv tax refund <br /> insrrucrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the <br /> subject of stored data on individua(s,and whether it is classified as public,private or confidendal. Upon his further request,an individual who <br /> is the subject of stored private or public dara on individuals shall be shown[he data without any charge to him and, if he desires,shall be informed <br /> of the content and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, [he data need not be <br /> disclosed to him for six months thereaher unless a dispute or acaon punuant to this secaon is pending or addiaonal data on the individual has been <br /> coltecced or created. The responsible authoriry shail provide copies of the private or public data upon request by the individual subject of the data. <br /> The responsible au[hority may require the requesring person to pay the actual cosu of making,certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately,if possible,with any request made pursuant to chis subdivision,or within five days <br /> of the date of the cequest,excluding Saeurdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with <br /> che request within that cime, he shall so inform the individual, and may have an addirional five days within which to comply with the request, <br /> excluding Saturdays, 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 <br /> private data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the <br /> d'uagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplece and attempt to nocify <br /> past recipienrs of inaccurate or incomplece dara,including recipients named by the individual; or(b)nocify the individual that he believes the data <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> "Ihe detzrminadon of the resporuible authoriry may be appealed pursuant to the provisions of the adminisffaave procedure act relatin� <br /> to contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with N1.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the City of Orono or any of its departments may require you to furnish certai.n <br /> private or confidential information. <br /> You are notified that: <br /> l. The information you furnish will be used to determine your qualification for the permit or license <br /> 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 <br /> process the pemut 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 1-+o�nr S � �:--q ,� S a'�- � r � <br /> Firsc Mid le < Last <br /> � t�- c1 � � � l✓c�;` I�-t1�J <br /> Address , <br /> `Z : �,I��'�e. � oL NI. � S`5���� 3 � � a - �-6� - � � a� <br /> C��Y State Zip Phone <br /> I understand my rights as stated above. <br /> � <br /> l �� �� � <br /> s�gnature <br /> 6 <br />