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. <br /> Sec.13.04 RIGHTS OF SUBJECTS OF D�TA <br /> Subd. 1. Type of data. The righ�s of individual on whom the data is s�ored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given individual. .4n individual asked to supply private or confidendal data concerning himself shall <br /> be informed of: (a)the purpose and in[ended use of the requesred data within the collecting'state agency,polidcal subdivision,or sratewide system; <br /> (b)whecher he may refuse oY is legally required to supply the requesced data;(c)any Irnown cocuequence arising fmm tus supplying or refusing to supply <br /> private or confidenrial data;and(d)the idenrity of other persons or enrides authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesri2aave dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propem tax refund <br /> instcuctions 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 whecher it is classified as public, private or confidendal. Upon his further request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown che data without any charge to him and, if he desires, shall be informed of the content <br /> and meaning of chat data. After an individual has been shown che private data and informed of its meaning,che data need not be disclosed to hirn for <br /> six months thereafter unless a dispute or acaon pursuant to this secdon is pending or addidonal data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authority <br /> may require the requesdng person to pay the acrual costs of makinc,certifying, and compiling[he copies. <br /> The responsible authoriry 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 not possible. If he cannot comply with the request <br /> wichin that time,he shall so inform the individual,and may have an addirional 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 pri�•ate <br /> data conceming himself. To exercise chis right,an individual shall nodfy in wriring the responsibie authoriry describing the nacure of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of <br /> inaccunte or incompiete data, including recipients named by the individual;or(b)noafy 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 included with the disclosed data. <br /> The determinarion of the responsible authoriry may be appealed pursuanc to the provisions of the adminisaarive procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Rights of subjects 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 furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the pemut or license. <br /> 3. The information may be shared with other local, state or federal agencies 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 certain rights under M.S. 13.04 (available upon request) to review private data on yourself. <br /> �X ur full name is r uired,; p cess this application �I• <br /> % �' c�'� � — - -��� <br /> j �� F —— <br /> F� st viiddlz _ � > Last <br /> �� � � Z �f �'f''��•r S c�_�/J/lJ'�'�� ��� � <br /> Add�ess - - /�a �� �.? �'�'\� � <br /> _ � � �,�, V J <br /> Ci ' State Zip Phone <br /> I underst g! as stated above. % � . <br /> , <br /> / <br /> ,; <br /> Signa[ure <br />