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<'�'� � <br /> ` � <br /> Sec.13.04 RIGH'tS OF SiJBJECTS OF D:�T?, <br /> Subd. I. Type of data. The rieh�s of individual on whom[he dara is stored or to ba stnred shall be as se�fonh in this secdon. <br /> Subd.2. Information reqirired to be given indirzdual. ?.n individual asked to supply private or confidzanal dara concerning himself shall <br /> be informed of: (a) the purpose and intended use of the requested data wichin the cotlecang'sta[e ageacy, poliacal subdivision,or statewide rystem; <br /> (b)whe�her he may refuse or is legally required[o supply the rquested data;(c)any irnown coasequeace arising from his supp(ying or refusing to supply <br /> � private or confidenrial dara;and(d)the idenriry of other persoas or enddes au�horized by state or federal law to receive[he data. This requiremenc stiall <br /> not apply when an individua!is asked to supply invesri�aave dara, pursuanc to secdon 13.82, subdivision 5, [o a law enforcemea[ofFccer. - <br /> Thz commissioner of revenua mav place [he norice r�auired under �his subdivision in the individual ir.come tax or provern tax refund <br /> inscrucaons inscead of on chose forms. <br /> Subd. 3. Access to data by individual. lipon request to a responsible auchoriry,an individual shall be informed whether he is the subject <br /> of s�ored da[a on individuals, and whe�her it is classified as public, privaee or conFidenrial. Upon his further request, an individual who is the subjecc <br /> of stored private or public daca on individuais shall be stiown�he dara wichouc any charge to him and, if he dzsires, shall be informed of the contenc <br /> and meaning of chat data. Afcer an individu3l has bzen shown rhe priva[e data and informed of ics meaning, tbe data need no[be disclosed to him for <br /> six mon[hs cherea[ter unless a dispute or acdon pursuanc to chis secdon is pending or addidonal data on the individual has been collzcted or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subjecc of che data. The responsible authoriry <br /> may require [he cequesring person to pay the ac�ual cos�s of making,cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immedia[ely,if possibl�, with any request made pursuant to this subdivision, or wi�hin five days of <br /> the date of the request,excluding Sacurdays,Sundays and le;al holidays,if immedia[e compliance is not possible. If he cannot comply with the request <br /> within that time,he shalt so inform che individual,and may have an addirional five days within which to comply with[he 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 completenzss of public or private <br /> data conceming himself. To exercise this rieht,an individual shall noa"ry in wridng che responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days eicher: (a)cocrect the da�a found to be inaccurate or incomplece and attempc to noafy past recipiencs of <br /> inaccurdte or incomplere data, including recipiencs named by the individual; or(b)noufy the individual that he believes the data to be correct. Data <br /> in dispuce shall be disctosed only if che individual's stacemenc of disagreement is included wich the disctosed data. <br /> The decerminadon of the responsible auchoriry may be appealed pursuanc to the provisions of che adminisa-adve procedure acc reladng to <br /> contesced 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 tha[your reques[ <br /> for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or <br /> confidential informa[ion. <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 da[a, but refusai may require that the City deny the permi[ or license. <br /> 3, The information may be shared wich o[her local, scate or federal a;encies 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 rioh[s under M.S. 13.04 (available upon request) to review private data on yourself. <br /> 6. Your fu11 name is required to process this application or permit. <br /> t 16,�J3-z.�) ��Li S I t����✓L - <br /> Firsc �tiddle Last <br /> �C� � /�'c�Ttr G�'� `"� � � ( <br /> Address .� <br /> �����c��-1 /22 ,� S� 7�(� �Y( - C'�c <br /> City State Ztp Phone <br /> un ers rights as stated a ove. <br /> � <br /> Signanire <br />