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� .a <br /> Scc.13.04 IiIGHTS OI�SUBJECTS 0['DATA <br /> Subd.1. Type of data. Thc rights of indi��idual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himsclf shall be <br /> infonned of: (a)the purpose and intended use of the requested data��ithin the collccting state agency,political subdivision,or statewide s,ystem;(b) <br /> whether he may refuse or is Icgally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement sliall <br /> not apply when an individual is asked[o supply investigative data,pursuant to section 13.82,subdivision 5,to a la�v enforcement officer. <br /> The commissioner ot revenue may place thc noticc required under this subdivision in the individual income tax or pronertV ta� refund <br /> instructions instcad of on those forms. <br /> Subd.3. Access to dafa by individuaL Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whMher it is classifed as public,private or conGdential. Upon his further request,an individual who is the subject of <br /> stored private or public data on individuals shall be sho���n the data without any charge to him and,if he desires,shall be intormed of the content and <br /> meaning of that data. Aftcr an individual has becn shown the private data and informed of its mcaning,the data necd not be disclosed to him for six <br /> months thereafter unless a dispute or action pursuant to this scction is pending or additional data on the individual has bcen collected or created. The <br /> responsible authority shall provide copies otthe private or public data upon request by the individuaf subject of the data. The responsible authority may <br /> require the requesting person to pay the actual costs of maldng,certifying,and compiling the copies. <br /> Thc responsiblc authority shall co�nply im�nediatcly,if possiblc,with any requcst made pursuant to this subdivision,or within five days of thc <br /> date of the requcst,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with thc reyuest within <br /> that time,he shall so inform thc individual,and may have an additional five days within which to comply with the requcst,excluding Satw�days,Sundays <br /> and Iegal holidays. <br /> Subd.4. Proccdure whcn datu is not accurate or complete. An individual may contest the accuracy or completeness of public or private data <br /> concerning himselL To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The <br /> responsible authority shall within 30 days eithci: (a)wrrcct thc data tound to be inaccurate or incomplete and attcn�pt to notify past rccipients of <br /> inaccurale or incomplete data,including recipicnts named by the individual;or(b)notify the individual that he bclicves the data lo be correct. Data in <br /> dispute shall be disclosed only if the individual's statement of disagrecment is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions of the administrative pirocedure act relating to <br /> contcsted cuses. <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 furnisli certain private or <br /> confidential information. <br /> You are noti�ed that: <br /> 1. The information you furnish will be used to deternune your qualification for tl�e 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 review private data on yourself. <br /> 6. Your full name is required to process this application or pernut. <br /> First Middle Last <br /> Address <br /> City Statc Zip Phone <br /> I understand my rights as stated above. <br /> Signature <br />