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. � <br /> � <br /> s«.i3.ua a�r,�rrs�>r si�a���;c-r•s or�a�i�� <br /> Subd I �IV�p�af data. �fhc rights of individual on whom thc data is storcd or to be stored shull be as set torth in this section. <br /> Subd.?.. Inli�rmation rcyuired to be given individual. An individual asked to supply privnteor contidential data conceming himself shall be <br /> intiirmcd of: (n)the purpose and intended use oY the requested data�vithin the collecting state agency,political subdivision,or statewide system:(b) <br /> �chethcr he mnv rotLsc or is legally royuired to supply thc requested d.11a;(c)any kno���n consequence arising from his supplying or rcfusing to supply <br /> pri����te or confidential data;and(d)tl�e identity ofoU�cr persons or entities authorized hy state or federal la���to receivethe data. This reyuiremei�tshall <br /> not<ipply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a law enforcement ofTicer. <br /> The commissioner ot�rcvenue mav place the notice rec�red under this sul�e�ivision in thu individual income ta�or roncrtv tax refund <br /> instructions instcad of on thosc fonns. <br /> Subd 3 nccess to data by individual. Upon request to.i responsibic autl�oriri�,an indi��idunl shall be intormed�vhether he is the su�ject of <br /> stored datn on indi��iduals,and�vhether it is classit�ied as public,private or confidential. Upon his further request,an individual�vho is the su�ject of <br /> stored private or public data on individuals shall he sho�cn the data�vithout any charge to him and.if he desires,shall be infonned ofthe content and <br /> meaning o(th.it data. Atter an individual h�is bccn shown the pri��ate data nnd informed of its mcaning the datn nccd not be disclosed to him ti�r si� <br /> months theroafter unless�dispute or action pursuant to this section is pending or addition�l d:uu on the individucil has been collectcd or created. l�he <br /> resF�onsible authority shal I provide copies of the privatc or puhl ic data upon reyuest by the indi�•idual su�ject of the d�tta. 'I�he responsible nuthority <br /> may requu�e thc rcquesting person ro pa��the actual costs of m�iking,certi�ying,and compilin�[he copies. <br /> I�he responsible authorit��shall compl��immediately_if possible,�vith any request made pursuant tu�his subdi��ision,oncid�in fi��ed.i��s of <br /> the date ofthe request,e�duding Saturdavs.SundaYs and legal hulida��s,il immedi�te compliance is not possible. If he clnnot romplc��ith the rcyuest <br /> �cithin that time_he shall so intbrm the individual,and ma�'have an additional fi��e dnys���ithin which to comply wi[h[he reques[,excluding Saturda��s. <br /> Sund,���s.�nd leeal I�olid�vs. <br /> Subd.d. Procedure�chen data is not accurateor complete. An individual mny contestthe accurac��or completeness ofpublic or private data <br /> concerning himself. To e�ercise this right.an individual shall notify in�vriting the responsiblu authority describing the naturc ofthedisagreement. 'fhe <br /> responsihle authoritv shall within 30 days either (a)correct the data lound to be inlccurate or incomplete and attempt to notifi�past rccipients of <br /> in�ccurute or incomplete dat2,including rccipients named by the individual:or(b)notit)-Uie individual that he believes the data to be correct Data in <br /> disputr sh111 be disclosed only if the individuaPs statement of disagreement is included�vith the disclosed duta. <br /> The detcrminntion of thc responsible�uthoritv may be appenlcd pursuant to the provisions of the cidministrui��c procedure act rclating to <br /> contcstc�ct�ses_ <br /> DATA PRIVACY nDVISORY <br /> In accorclance���ith M.S. I 3.04.Suhd.2_"Rights of subjects of data".wc���oulcl like to inlbnn��ou that your requcst <br /> liir a permit or liccnse from the Cit�� of Or<>no or uny of its departments may rcquire you tu f�urnish cert�iin private or <br /> cunlidential inlbrmation. <br /> You arc notified that: <br /> l. "['he information you f�urnish ���ill be used to determine your qualification {or the permit or license <br /> requested. <br /> 2. You may refuse to supply data,but refusal ina}� rcquire that the Cit}� dci�y the permit or license. <br /> 3. The intormation may be shared with other local, state or lcderal agencics to the extcnt necessaiy lo <br /> process the permit or license. <br /> 4. (f your rcquested pa�init or liccnsc req��ires Council action to approve, some iniormation may bccomc <br /> public. <br /> >. Yuu have certain ri�!hts under M.S. 13.04(nvailable upon request)to rc��ic�e private data on yoursclf. <br /> 6. Ye�ur full name is ra�uircd tu process this application or permit. <br /> �Q h n.3 CGl�l Ct s ! f �-+-"� <br /> First Middle L:+st <br /> � I �� 1 J t�/11.3 Uc�(.�,�, �/'� <br /> 1ddress <br /> ��v,�..v 1'�'l�/ S`?�3 9/ �S;Z- Y�3 -i�'� �� <br /> Cit� Statc 7.ip Phonc <br /> i underst�ncl, y ights as stated above <br /> � <br /> �c�� '1..��----� <br /> Signahn-c <br /> Reset Fonn 32 <br />