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Sec.13.04 RIGH'TS OF S[IB.TECTS OF DaTA <br /> Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be scored shall be as set for[h in this secdon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal dara concerning himself shall <br /> be informed of: (a) [he purpose and intended use of the requesced data within the collecting"state agency, political subdivision,or sratewide system; <br /> (b)whe[her he may refuse oY is legafiy required to suppty che requested data;(c)any Imown consequence arising from his supplying or refusing ro supply <br /> private or confidential data;and(d)the identity of other persons or enrides authotized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesdgadve dara, pursuant ro secdon 13.82, subdivision 5, ro a law enforcement officer. <br /> The commissioner of re�enuz mav place the nodce reauired under this subdivision in the individual income tax or propercv tax refund <br /> instructions instezd 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 confidential. Upon his funher request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the content <br /> and meaning of that data. Aftzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for <br /> six months thereafter uriless a dispute or acrion pursuan[to chis secrion is pending or addidonal data on the individual has been collected or created. <br /> The responsiblz authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesting person to pay che accual costs of making, cerafying, and compiling the 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[he request,excluding Sa[urdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an additional five days within which to comply wi[h 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 pubtic or prn•ate <br /> data conceming himself. To exercise[his rieht,an individual shall nodfy in wri[ing the responsible authoricy describing�he na[ure of the disagreement. <br /> The responsible authoriry shall within 30 days either. (a)correcc the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipien[s named by che individual; or(b)notify the individual tha[he believes the data to be correc[. Data <br /> in dispuce shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. <br /> Tlte decermination of the responsible authoriry may be appealed pursuan[to the provisions of the administnrive procedure act relating to <br /> conrested cases. <br /> DAT:� PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "RiQhts of subjects of data", we would like to inform you that your reauest <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 permit or license. <br /> 3, The information may be shared with other local, state or federal agencies to the extent necessary to process <br /> the pernut 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 /> 6, Your full name is required to rocess this application or�rmit. <br /> �i.5 C�. ����� <br /> r �: �-�--- <br /> t" �� �- � � <br /> First /� <br /> iddle Las[ <br /> ( �X �� M d�C�0.� <br /> Addre�ss ��,��'� � J J7�� �l S�'���������� <br /> ( 'r�'l c� � <br /> ��ry State Zip Phon <br /> I understand my rights as stated above. � <br /> �� � ;��-��� '� ' � ---� <br /> _._ <br /> _. . <br /> "" � ' / t�� � <br /> J _ <br /> ) � -�'" j' �,�'� c,� �„ u�-- �- �� <br /> � t �4 -'v <br /> Signamre � <br />