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r <br /> Sec.13.04 RIGHTS OF SIJB.TECTS OF DaTa � <br /> Subd. 1. Tvpe of data. The riehcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given indiridual. �.n individual asked to supply private or confidendal dara concerning himseif shall <br /> be informed of: (a) the purpose and intended use of che requesud data wichin[he col]ecdng"state agency, polidcal subdivision,or sratewide system; <br /> (b)w'he�her he may refuse oY is legatly required to supply[he requested data;(c)any Irnown consequence arising from his supplying or refusing to supply <br /> privace or conndennal data;and(d)the idenrity of ocher per5ons or enrides authorized by state or federal law to receive the data. This requirement shall <br /> noc apply when an indieidual is asked to supply invesrigadve data, pursuan[to secdon 13.82, subdivision 5, to a(aw enforcement o�cer. <br /> 'I1�e commissioner of re�enue r-iav place the norice rEouired under this subdivision in the individual income tax or proper[v tax refund <br /> ins;ruc�ions inscead of on chose forms. <br /> Subd. 3. Aecess to data by indi�-idual. Upon requesc to a responsible auchoriry,an individual shall be informed whether he is[he subjecc <br /> of scored data on individuais, and whecher it is classified as public, privace or confidenrial. Upon his further request,an individual who is the subjecc <br /> of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he dzsires, shall be infoaned of the content <br /> ar.3 meaning of�hat da[a. Afrer an individual has been shown ehe privace data and informed of ics meaning, che data need not be disclosed to him for <br /> six II:on[hs thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal data on the individual has been collected or created. <br /> The responsible auchoriry shall provide copies of the priva[e or public data upon request by the individual subject of the dara. The responsible authoriry <br /> may require the requesring person to pay the ac�ual costs of malcing,cerofying,and compiling the copies. <br /> 1fie responsible authoriry shall comply immediaczly, if possible, wi�h any requesc made pursuant to this subdivision, or within five days of <br /> che dace of the request,exciuding Sanirdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comp(y with the request <br /> wichin thac rime,he shall so inform che individual,and may have an addirional five days within which to comply wi[h the request,excluding Saturdays, <br /> Sur.days and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comp(eteness of public or private <br /> daca conceming himseif. To exercise�his riehc,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreement. <br /> The responsib(e au�horiry shall wi[hin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempc to norify past recipienu of <br /> ir.ac:ura[e or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be coaect. Data <br /> in dispu[e shali be disclosed only if the individuai's statemen[of disagreement is included with the disclosed data. <br /> Ttie de[erminarion of the responsible au[hority may be appealzd pursuanc to the provisions of[he administrarive procedure act reladng to <br /> con�ested 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 reauest <br /> for a pernut or license from the Ciry 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 that the Ciry deny the permit or license. <br /> 3. The information may be shared with other local, state or federal a�encies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested pemut or license requires Council action to approve, some information may become <br /> public. <br /> j. You have certain rights 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 perm.ic. <br /> � <br /> Ii �s ��:�� ; i�'l:; l I�,- <br /> ' , Lasc <br /> First �fiddie <br /> '71���,J '��.�lS �' 'V �, <br /> Address ��1�l;' �� '� '� I � �� � �� `, '��� ����� <br /> ,� � � <br /> i �"� <br /> Ciry State Zip Phone <br /> I understand my ri�hts as stated above. <br /> �,j�i'� ��"�� <br /> ; � <� -----_"—_�--- <br /> Signature <br /> v <br />