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Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set focZh in this secdon. <br /> Subd.2. Information required to be given individual. r1n individual asked to supply private or co�dendal data co�ceming himself shall <br /> be informed of: (a) the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or statewide system; <br /> (b)whether he may refuse or is leeally required to supply the requestzd data;(c)any imown consequence arising from his supplying or refusing to supply <br /> private or confidendai data;and(d)the identiry of other persons or entides authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invescigadve data, pursuant ro secdon 13.82, subdivision 5, to a(aw enforcement o�cer. <br /> The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propem tax refund <br /> instrucrions instead of on[hose forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individuai shall be informed whether he is the subject <br /> of stored data on individuals, and whether it is classified as public, private or confidencial. Upon his further request,an individual who is the subject <br /> of stored private or pubtic data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown[he private data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the individual has been collected or crea[ed. <br /> The responsible authority shall provide copies of the private or pubtic data upon request by the individual subject of the data. The responsible auchoriry <br /> may require the requesting person to pay the actual costs of making, certifying, and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant ro this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possib(e. If he cannot comply with the requzs� <br /> within that time,he shatl so inform the individual,and may have an addido�al five days wi[hin which to comply with the request,excluding Saturdays, <br /> Sundays and leeal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may con[est the accuracy or completeness of public or pri�atz <br /> data concerning himself. To exercise this rieht,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shafl within 30 days either. (a)correc[[he data found to be inaccurate or incomplete and attempt to nonfy past recipien[s of <br /> inaccurate or incomplete data, including recipients named by the individuaf; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determina[ion of the responsible authoriN may be appealed pursuant to the provisions of the administrative procedure act relating to <br /> contes[ed 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 that your request <br /> for a pernut or license from the City of Orono or any of its departments may require you to furnish cer[ain 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 pemut or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the pernut 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 /> $. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (. Your full name is required to process this application or permit. <br /> � 1 c�F� � �> �� r-5 � l� <br /> First <br /> vf iddle Last <br /> � �> 3 . <br /> Address <br /> � , IGL� �, ,,-�� �.% � � � �� � �� 37�� <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> �.f',1.��" � • �2�-�� — <br /> Signature <br />