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� <br /> . <br /> t <br /> Szc.13.04 RIGHTS OF StiBJECTS OF D�T?, <br /> Subd. 1. T}�pe of data. "Ihe nghts of individual on whom[he data is stored or to be stored shall be as se[Torth in this secdoo. <br /> Subd. '_. Information required to be�ven indicidual. .�.n individual asked to supply private or confidendal dac3 concecning himself shall <br /> be iniormed of: (a) the purpose and incendzd use oi the requested daca wi�hin the colleccing'state aoency, pol[dcal subdivision,or sta[ewide system; <br /> (b)whe�her he may reiuse or is le�ally required to suppiy che;equested daca;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidennal daea:and(d)rhe idendcy ot other^ersons or er,ades authorized by state or federal law ro receive the data. This requirement shall <br /> no[apply when an individual is asked to supply invesoganve da[a. pur�uant[o seccion 13.32, subdivision�, to a law enforement orficer. <br /> The commissione: oi rever.ue ma� olace �he r.odce reeuired under chis subdivision in Lhe individual income [az or vropem tax refur.d <br /> ins�:uctions inscead uf on �nosz forms. <br /> Subd. 3. .�ccess to data by individual. L"pon reauesc[o a responsiblz au[honty,an individual shall be inforcned whe�her he is the suoject <br /> ot stored data on individuals, and whe�her it is cfassitied as puolic, pnvaee or contidendal. lipon his t"ur[her request, an individual who is[he subject <br /> of stored priva[e or public data on individuals shall be shown the data wi�hout any charge to hun and, if he desires, shail be informed of the conien[ <br /> and meaning of tha[data. .-�fter an individual has been shown�he pnvate daca and informed of ia meaning, the data need not be disclosed to hun ior <br /> six months[hereatter unless a dispu[e or acdon pursuan�:o �his secdon is pending or addidonal data on the individual has been collec[ed or created. <br /> The responsibie aurhority shall provide copies oi the pri�ace or puolic data upon request by[he individual subject or the data. The responsible auchority <br /> may require che requesnng person to pay the acmal coscs of malcing. cerdfying, and compiling the copies. <br /> The responsible authonty shall comply immediacely, if possible, with any request made pursuan[ro this subdivision, or within five days oi <br /> the date otthe request, excfuding Sa[urdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannoc comply wich[he requesr <br /> wi[hin[hat cime,he shall so iniorm the individual,and may have an addidonal five days wi[hin which to compiy wich the request,excluding Saturdays, <br /> Sundays and legal hoiidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may concest[he accuracy or completeness of public or private <br /> data concemine himseif. To exercise chis rieht,an individual shall notity in wri�ing[he responsible auchority describing the na[ure of the disagreement. <br /> The responsible auchori[y shall wichin?0 days ei[her. (a) correct the data tound to be inaccurate or incomplete and attemot to norify past recipients oT <br /> inaccurate or incomplete data, includine recipien�s named by the individual; or(b) nodfy the individual that he believes the data[o be correct. Data <br /> in dispute shall be disclosed only if the individual's stacemen[of disagreement is included wich the disclosed data. <br /> The determination of the responsiole auchoriry r.iay be appealed pursuant to �he provisions of the admuustradve procedure act relanne to <br /> conces�ed cases. <br /> DaT:� PRIV?,CY aDVISORY <br /> In accordance wich M.S. 13.04, Subd. �, "Rights of subjects of data", we would like to inform you that your request <br /> for a permi[ or license rrom the Ciry or Orono or any of its departments may require you to furnish certain private or <br /> confidential inTormation. <br /> :ou are r.ocified chac: <br /> 1, The information you furnish will be used to decermine your qualification for the permit or license requested. <br /> � You may refuse to supply� data, but refusal may require that the City deny the permit or license. <br /> 3. Ihe information may be shared witn ocher local, state or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> public. <br /> �, You have certain ri�hts under �1.5. 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 /> r � �-�,r�/C� c <br /> First �tidCle Las[ <br /> � �/� �� �,�� d /� � ,:� <br /> Addres / %� � (y <br /> J�,� �� ��.�.3 <n Lf �� 4 <br /> i <br /> Ciry Sta�e Zip Phone <br /> I underscand my rights as stated above. <br /> Signa[ure <br />