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V _ <br /> _ , <br /> Sec.13.04 RIGHTS OF Si1BJECTS OF DATA <br /> Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be scored shall be as set forth in this section. <br /> Subd.2. Informa[ion reqtirired to be given individual. Att individual asked to supply private or confidenaal data concerning himself shall <br /> be informed of: (a)the purpose and iatended use of the requested dara within the collecang'state ageacy, poliocal subdivision,or statewide system; <br /> (b)whethe�he may refuse oY is legally required ro supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply <br /> � private or confidendai data;and(d)the idenary of other persons or enades auchorized by state or federal law to receive the data. This requiremenc shall <br /> not apply when an individual is asked to supply invesrieaave dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. - <br /> The commissioner of re�enu� mav ptace che noace reauired under this subdivision in the individual income tax or propem tax refund <br /> instrucdons instead of on chose forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whecher it is class�ed as public, private or confidential. Upon his further request,an individual who is the subject <br /> of stored private or pub(ic dara on individuals shall be shown che data wichout any charge to him and, if he dzsires, shall be informed of the content <br /> and meaning of chat data. After an individual has been shown che privace data and informed of its meaning, the data need not be disclosed to him for <br /> six monchs rhereaiter unless a dispute or acdon pursuanc to chis secrion is pending or addidonal data on the individuai has been cotlected or creat�d. <br /> The responsible authoriry shall provide copies of the privace or public data upon requesc by the individual subject of che data. The responsible authoriry <br /> may require the requesdng person to pay the actual cos�s of making, certifying, and compiling the copies. <br /> The responsible authoriry shall comply immediatzly, if possible, with any request made pursuant co this subdivision, or wichin five days of <br /> the dace of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wi[h the requesc <br /> wi[hin chac tune,he shall so inform[he individual,and may have an addidonal five days wirhin which to comply wich the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest thz accuracy or completeness of public or pri�•ate <br /> data conceming himself. To exercise this right,an individuai shall norify in wriang the responsible authoriry describing the nature of the disagreement. <br /> The responsible au[horiry shall within 30 days either: (a)correct the data found to be inaccurate or incomp(ete and attempt to noafy past recipien�s of <br /> inaccurare or incomplete data, including recipients named by[he individual; or(b)nodfy che individual that he believes the data to be coaec[. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The de[erminarion of the responsible au[horiry may be appealed pursuant to the provisions of the admuustrarive procedure act relaring to <br /> concesced 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 certain 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 permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require tha[ the City deny the permit or license. <br /> 3. The informa[ion may be shared with other locai, 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 /> j. You have certain ri�hts 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 /> �c�'��n ���~ ��a � <br /> First yfiddle Lasc <br /> 1 SsC�v �%Gc'��o-x /� S�o - <br /> ;�S, C"vv� S �,/�7��� ��'�'-. j`��C S 9� -a� `�� <br /> Ciry State Zip Phone <br /> I unders[and rights as sta[ed above. <br /> �t����% <br /> Signature <br />