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Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individuai on whom the data is s[ored or to be stored shall be as set forth in this section. <br /> Subd.2. Information required to be given indiridual. An individual asked to supply private or confidenaal dara concerning himself shall <br /> be informed of: (a)the purposc and incended use of the requested data wichin the collecring'state agency, polidcal subdivision,or sratewide system; <br /> (b)whether he may cefuse or is legally required ro supply the requested dara;(c)any�own coasequence arising from his supplying or refusing to supply <br /> privace or confidendal data:and(d)the identiry of other persons or enaries authorized by state or federal law to receive the data. 'Ihis requirement shall <br /> not apply when an individual is asked to supply invesrigadve dara, pursuant[o secrion 13.82, subdivision 5, ro a law enforcement o�cer. <br /> "Ihe commissioner of re�enue mav lace the noace re uired under this subdivision in the individual income tax or ro ertv taz refund <br /> instrucrions instead uf en those forms. <br /> Subd.3. �ccess 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 i[is classified as pubiic,private or confidenaal. Upon his funhe�request,an individual who is the subject <br /> of stored privace or public dara on individuals shall be shown[he data without any chacge to him and,-if he desires, shall be informed of the conrenc <br /> and meaning of that dara. After an individual has been shown the private data and informed of i6 meaning,the data need not be disclosed to him for <br /> six monrhs thereafter uniess a dispu[e oc action pursuant to this section is pending or additional data on the individual has been collecced or creared. <br /> The responsible au[horiry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible auchoriry <br /> may require the requesring penon to pay the actual costs of making, cerrifying, and compiling the copies. <br /> The responsible au[horiry shall comply immedia[ely, if possible, with any reques[made pursuant to this subdivision,or within five days of <br /> the date of the request,ezcluding Saturdays,Sundays and legal holidays, if immediaee compliance is not possible. If he cannot compiy with the reques[ <br /> within that rime,he shall so inform the individual,and may have an addidooal five days wi[hin 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 conceming himseif. To ezercise this right,an individual shall nocify in writing the responsible authoriry describing the nature of the disagreement_ <br /> The responsible au[hority shall within 30 days either: (a)correct the data found to be inaccurate or uicomplete and attempt to nodfy past recipiencs of <br /> inaccurate or incomplete da[a, including recipients named by the individual; or(b)nodfy the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data. <br /> The determinadon of the responsible authority may be appealed pursuant to the provisions of the ad[ninistradve procedure act relating co <br /> contested cases. <br /> DATA PRIVACI' ADVISOP.Y <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 fumish will be used to determine 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 permit or license. <br /> 3, T'he information may be shared with other local, state or federal agencies to che extent necessary [o 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 /> j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (, Your full name is required to process this application or permit. <br /> �C�.S �. <br /> � ���� �, <br /> F��� iddle �� <br /> � �� ��.� � � <br /> Address _ <br /> c.-��� �'Z�n� �S3�15 vl �-`-�3'��-4�76� <br /> �L '� Phone <br /> Ciry State Z�? <br /> nderstand my rights as stated above. <br /> � C—C"�'/ �� <br /> Signature <br />