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• , s <br /> 5ec.13.04 RIGHTS OF SUBJECTS OE DATA <br /> Subd.1. Type oi data. Thc rights of individual on whom the data is stored or to bc stored shall be as set(orth in this section. <br /> Subd.2. lnformation required to be given individual. An individual asked to supply private or confidential data concerning himself shall be <br /> in[or�ned oL• (a)the purpose and intended use of thc requestcd data�vithin the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is Iegally required to supply thc requcsted data;(c)any known consequence arising fro�n his supplying or refusing to supply <br /> private or con(idential data;and(d)the identity of other 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 enCorcement of[icer. <br /> The commissioner of rcvenue mav place the notice required under this subdivision in the individual income tas or nropertV taa refund <br /> instructions instead of on those for�ns. <br /> Subd.3. Access to data b��individual. Upon request to a responsible authority,an individual shall be informed whethen c�is the subject of <br /> stored data on individuals,and whether it is classified as public,private or confidential. Upon his further 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 I�e desires,shall be informed of the content and <br /> meaning of that data. A[ter an individual has been shown the private data and informed o(its meaning,the data need not be disclosed to him for six <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has bcen collected or created. The <br /> responsible authority st�all provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may <br /> require the requesting person to pay the actual costs o[ma{:ing,certifying,and compiling the copies. <br /> Thc responsible authority shall comply i�nmediately,if possible,with�ny request made pursuant to this subdivision,or within five days of thc <br /> date of thc request,escluding Saturdays,Sundays and Iegal holidays,if immediate compliance is not possible. If he cannot compl��with the request within <br /> that time,hc shall so inform thc individual,and may havc an additional five days within which to comply with the request,excluding Saturdays,Sundays <br /> and Iegal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. Ao individual�nay contest the accuracy or completeness of puhlic or private data <br /> concerning himsclL To esercisc this right,an individual shall notify in writing thc responsible authority describing the naturc of the disagrcemcnt. The <br /> responsible authority shall within 30 days either: (a)correct the data found to bc inaccurate or incompletc and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he bclieves the data to be correct. Data in <br /> dispute shall be disdosed only if the individual's statement of disagrecmen[is included with thc disclosed data. <br /> The determination of the responsible authority may be appcaled pursuant to the provisions of the administrative 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 inform you that your request <br /> for a pernrit or license from the City of Orono or any of its departments n�ay require you to furnish certain private or <br /> confidential infbrmation. <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 revie�v private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> 1�'��L�1.1t� ��2� �J �--�.�,=TL <br /> First Middle Last <br /> 2S < � 1= �Z �� � <br /> Address <br /> _�Q�.--s � S s � �1 �[ Z — � z � � t�'�c7 <br /> C�ty State Zip Phonc <br /> I und rstand rights as stated above. <br /> Signature <br />