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f <br /> Scc.13.04 R[GEITS OF SUBJECTS OF DATA � <br /> Subd. l. Type of data The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. [nfonnation required to be given individual. An individual asked to supply private or confidential data conceming himselfshall be <br /> informed of: (a)the purpose and intended use ofthe requested data�vithin the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may retLse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusin�to supply <br /> private or confidential data;and(d)the identity of other persons or entities authorized by stare or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a law enforcement officer. <br /> The commissioner of revenue makplace the notice required under this subdivision in the individual income tax or properry tax refund <br /> instructions instead of on those fonns. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whedier it is classitied as public,private or contidentiaL Upon his further request,an individual who is tlle subject of <br /> stored private or public data on individuals shall be shown the data���ithout any charge to him and,if he desires,shall be in£ormed of the content and <br /> meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible aufhority <br /> may require the requesting person to pay the actual costs of makine,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of <br /> thedateoftherequest,ezdudingSaturdays,Sundaysandlegalholidays,ifimmediatecomplianceisnotpossible. [fhecannotcomplywiththerequest <br /> within that time,he shall so infonn the individua(,and may have an additional tive days within which to comply with the request,excludine 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 data <br /> conceming himself. To exercise this ri�ht,an individual shall notify in writing the responsible authority describing the nature ofthe disagreemenC The <br /> responsible authority shall�vithin 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to noti'ty past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he bei ieves the data ro be correcc Data in <br /> dispute shall be disclosed only if the individuaPs statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 inforn�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 /> l. The information you furnish wilt be used to detennine your qualification for the permit or (icense <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 infonnation may be shared with other local, state or federal agencies to the extent necessary to <br /> process 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 1�LS. 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 /> �b���- � ��=.a�� <br /> First �liddlc Last <br /> 3�`�S �—� ��< UVl�--� S� <br /> Address <br /> 'v1�-ju���rzt Ul�,l�-� S�S�'J�S� `1�Z - �.�7�2�`l� <br /> Ci[y Siate "/_ip Phone <br /> I understand mv ri hts as; tated above. <br /> Signa urc <br /> Reset Form 3� <br />