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, � <br /> Sec.13.0� RIGHTS OF SUBJECTS OF D 1TA <br /> Subd. 1. Type of data. The ri�hts of individual on�vhom the data is stored or to be stored shall be as se[forth in this section. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himselfshall be <br /> infonned of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or contidential data;and(d)the identiry ofother persons or entities authorized by state 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 5,to a law enforcement officer, <br /> The commissioner of revenue mav olace the notice required tuider this subdivision in the individual income tax or proper[v tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon requestto a responsible audiority,an individual shall be infonned whether he is the subject of <br /> stored data on individuals,and whether it is classitied as public,private or contidentiaL Upon his fuRher request,an individual who is the subject of <br /> stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed ofthe content and <br /> meaning of that data. After an individual has been show�n the private data and infonned of its meaning the data need not be disclosed to him for six <br /> months tliereafter unless a dispute or action pursuant to diis secfion is pending or additional data on HZe 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 authoriry <br /> may require the requesting person to pay the actual costs of making,certih�ing,and compiling the copies. <br /> The responsible authority shall comply iinmediately,if possible.with any request made pursuant to this subdivision,or�vithin tive daYs of <br /> the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot comply with the request <br /> �vithin d�at time,he shall so inform the individual,and may have an additioiial tive days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> S ubd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data <br /> concerning himselP. To exercise this righ[,an individual shail notify in writing the responsible authori[y describing the nature of the disagreement The <br /> responsible authority shall�vithin 30 days eithcr (a)correct the data found to be inaccurate or incomplete and attempt to notity past recipients of <br /> inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he Uelieves the data to be correc[. Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is induded with U�e�isclosed data. <br /> The determination of the responsible authonty may be appealed pursuant ro the provisions of the adminisvative 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 /> 1. The information you fumish will be used to detern�ine your qualification for the permit or license <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 information may be shared with other local, state or fedcral agencies to the extent necessary to <br /> -• process the pern�it or license. <br /> 4. If your requested permit or license requires Council action to approve, some in�farmation may become <br /> public. " <br /> 5. You have certain rights under M.S. 13.04(availab(e upon request)to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> �n�G'�-�=r `J �G}����s-'- <br /> First � �liddle Last <br /> �( Oc��./�!� �- - <br /> :d�r:sS <br /> � �l�a N�� , .��s�.� ( �iz) ��s- 9iqa <br /> Citv StAtc Zip Phonc <br /> ( un�r tand my rig s as stated above. <br /> � � <br /> gnaturc <br /> Reset Form .i� <br />