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. . <br /> Szc.13.04 RIGHTS OF SLTB,TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forrh in this secaon. <br /> Subd.2. Information required to be given indiridual. An individual asked to supply private or confidendal data conceming himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide <br /> rys�em;(b)whe�her he may refuse or is legally required to supply the requested data; (c)any Imown consequence arising from his supplying or <br /> refusing to supply privare or coafidenoa]dara;and(d)the idenary of other persons or endries authorized by sate or federal law to receive the data. <br /> This requirement shail not apply when an individual is asked to supply investigacive dara, pursuant to secaon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav lace the norice re uired under this subdivision in the individual income taz or ro errv tax refund <br /> insrrvcrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authority,an iadividual shall be informed whether he is the <br /> subject of stored data on individuals, and whether it is classified as public,private or contidential. Upon his fur[her request,an individual who <br /> is the subject of s[ored private or public dara on individuais shall be shown the data withouc any char;e to him and, if he dzsires, shall be informed <br /> of the conten[and meanin�of that data. After an individual has been shown the private data and informed of its meaning, the data need not be <br /> disclosed to him for six months thereafrer uriless a dispute or acdon pursuant to this section is pending or addirional data on the individual has been <br /> collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. <br /> 'I'he responsible authority may require the requesting person to pay the actual cosu of making,certifying, and compiling the copies. <br /> The responsibie authoriry shall comply immediately,if possible,wich any requesc made pursuant to this subdivision,or within five days <br /> of the date of the request, exciuding Saturdays, Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply wirh <br /> the request within that dme, he shall so inform the individual, and may have an addicional five days within which to compty with the request, <br /> excluding Saturdays, Sundays and lega]holidays. <br /> Subd.4. Procedure whea data is aot accurate or complete. An individual may contes[the accuracy or completeness of public or <br /> private da[a conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nacure of the <br /> disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy <br /> past recipiencs of inaccurate or incomplete dara,including recipients named by the individual;oc(b)notify the individual that he believes the daca <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is inctuded with the disclosed data. <br /> The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisffaave procedure act relaang <br /> ro contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance wich M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from [he City of Orono or any of its departments may require you to furnish certain <br /> private or 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 <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. <br /> 3. The information 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 M.S. 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 /> > <br /> iC v�� �M- �C��%�t�� <br /> Firsc Middlz Last <br /> � <br /> -.�S �, ��,S;a�_ (_.r�t_ � yZn <br /> Address <br /> (J ��.e>'��C� �,t.( S��� s�� �'S � � <br /> �s�z - Y��� � <br /> C�ry State Zip Phone <br /> I understand my i;hts as stated bove. <br /> �C-� � <br /> ; <br /> 6 <br />