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� . • <br /> Sec.13.04 RIGHTS OF SUBJECTS OF D�Ta <br /> Subd. !. Type of daU. 'Ihe righu of individual on whom�e dan is stor_d or w be scored shall be u sec forth in this secaon. <br /> Subd.2. Information reqiric�ed to be givm individual. An ir.�i�idaai azkcd w supply private or confidendal data concemiag himself shalt <br /> be informed of: (a)che purpose and inrended use of the rsquested dan wi�in the collecung�tace agency,poliacal subdivision,or statewide rystem; <br /> (b)whecher he may refuse oti is legally required to supp(y the cequasced dara:(c)any I�own consequeace arising trom his supplyiag or refusing co supply <br /> privace or conndenaal data;and(d)the idendcy of other persoos or enrirics acthorized by state or federal law m crceive the data..This requiremenc shall <br /> noc apply when an indir•iduai is asked to supply invesdgadve darr,punv�^t w secaoa 13.83,subdivision S,to a law tnfor�ement o�cer. <br /> Ihe commissioner of re�eaue r�av place the noace rewired erd-r ehis svbdivision in the individua! ir.come tax or prooem ax refund <br /> instrucrions inscead of on those forms. <br /> Subd.3. Access to data by indi�-idual. Upon request to a cesroosibie acc*oricy,an individual shall be inform�d whether he is che subject <br /> of stnred data on individuats,and whether it is classified as Qublic,privae or confider.aal. Upon his funher request, an individual who is the subjecc <br /> of scorai private or public da[a on individuals shall be shown che da[a w•i�out any c':�rge to him and;if he dasires,shall be informed of the contcnt <br /> and meanin8 of rhat dara. Afur an individua[has been shown che priva�2ac+and ia:ormed of ics meaning,the dara need not be d'uclosed to him for <br /> siz months d�ereai�er unless a dupute or acrion purnunt w chis seccion is;.ending or addiooaal data on the individual has been collecced or creaced. <br /> 'Ihe responsible au[hotiey shaU pcovide copies of the private or public dac�e�on reqaes,by the individual subject of the daca. The responsible authoriry <br /> may requir:the requesting person to pay the acaial cosu of makin¢,ce.=:;ing,az:d compiling the copies. <br /> 'Ihe responsible authoriry shall comply immedia�ely,if possib!:,wich any rquesc made pursuant to this subdivision,or wichin five days of <br /> ttte dan_of the ceques4 excluding Sacucdays,Sundays and legal hotidays,ii immediace compliance is not possibla If he cannot comply with the requac <br /> wirhin thac cime,he shall so infoim rhe indiridual,and may have an addi�e;.ai five dati s wichin which ro compiy with[he cequest,ezetuding Saairdays, <br /> Sundays and Icgal holidays. <br /> Subd.4. Procedure when dnta is not accurate or complete. �n individual may conust[hz accuracy or compteteness of public ar prieace <br /> daa conceming himself. To exercise chis right,an individual shalI nodfy u wridng ce responsible aurhoriry describing rhe nacure of the disagreemenc. <br /> 'Ilic responsible auchoriry shali within 30 days eitkter. (a)comect the dae icund to Ee inaccurste or iiuompiete and aaempt to norify pasc recipients of <br /> inaccurate or ineomplete data, ineiuding�ecipiencs named by the individi:ai;or(b)�odfy the individual that he believes the data to be eotrect. Dac� <br /> in dispuce shall be diselosed only if the individual's sta[emene of disagra�_nc is i.c:idad with the disetosed data. <br /> 'Ihe decerminarion oE the rasponsible authoriry may ba appea:e�pursuaLc to [he provisions of[he adminisaarive procedure act reladng to <br /> conusud cases. <br /> DATA PRIV;�CY AD�'ISORY <br /> In accordance with M.S. 13.04,Subd.2, "Rights of subjects oi data", we would like to inform you that your reouest <br /> for a pecmit or license from the Ciry of Orono or any oi i� depar�ments may require you to fumish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1, The information you fumish will be used to dz:ermine}•our qualification for the permit or iicense requested. <br /> 2. You may refuse to suppiy data, but refusal may require that the Ciry deny the permit or license. <br /> 3, The information may be shared wich other loc�1, state or federal agencies ro the ex[ent necessary to process <br /> the permit or ticense. <br /> 4. If your requested permit or license requires Council action to approve, some informacion may become <br /> _ public. <br /> �. You have certain rights nnder M.S. 13.04 (a�ailable Lpon request) to review private data on yourself. <br /> (. Your fuli name is required to process this zoplica[ion or permit. <br /> �c��� ,., G/� I-��� �� Lp �� <br /> Firsc vtid Last <br /> S� <br /> Addtess <br /> � �� �o /i�1r�1 5535(� ��-'-�73 �1��1_ <br /> Ciry State Zip Phone <br /> I understand my riahu as stated above. <br /> Signacure <br />