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� 1t <br /> . . , <br /> Sec.13.04 RIGHT'S OF SUBJECTS OF D:�TA <br /> Subd. I. Type of data. The riehrs of individual on whom[he data is stored or to be stored shall be as set focth in this secrion. <br /> Subd.2. Information reqirired to be given individual_ An individual asked to supply private or confideaaal dara conceming himself shall <br /> be informed of: (a) the purpose and intrnded use of the requesred dara wi[hin the collzcang"sta[e a�ency, polidcal subdivisioa,or sratewide system; <br /> (b)whe�hec he may refuse or is legally required co supply the requested data;(c)any irnown coasequeace arising from his supplying or refusing to supply <br /> • private or confidenaal dara;and(d)the idenaty of other persons or enriries au[horized by state or federal law to receive the dara. "Ihis requiremen[s�ali <br /> not apply when an individual is asked co supply invesdgadve dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcemenc officer. - <br /> The commissioner of revenu� mav pface the noace r�ouired und�r this subdivision in the individual income tax or prooerrv tax refund <br /> inscrucrions inscead of on chose forms <br /> Subd. 3. Access to data by indi�idual. lipon requesc to a responsible aurhoriry,an individual shall be informed whether he is the subject <br /> of scored data on individuals,and wherher ic is classified as public, privace or confidenrial. Upon tvs further requesc,an individual who is the subjecc <br /> of stored private or public dara on individuals shall be shown[he data wi�houc any charge to him and,�if he desires, shall be informed of the concenc <br /> and meaning of chat data. Afrer an individu3!has been shown[he priva[�data and informed of ics meaning, the data need no[be disclosed to him for <br /> six monchs chereafcer unless a dispu[e or acrion pursuan�co chis secrion is pznding or addiaonal dara on the i�dividual has beea collzcced or creaced. <br /> The responsible authoriry shall provide copies of the private or public data upon request by�he individual subjecc of the data. The responsible authoriry <br /> may require the requesring person to pay the accual costs of making, cerrifying,and compiling the copies. <br /> The responsible aurhoriry shall comply immedia�eiy,if possible, wich any rzquest made pursuant co this subdivision,or wirhin five days of <br /> the da�e of che requesc,excluding Sacurdays,Sundays and legal holidays,if immzdiate compliance is not possible. If he cannot comp(y with the reques[ <br /> wi�hin chac time,he shall so inform che individual,and may have an addirional five days wirhin which to compiy wich che requesc,excluding Sacurdays, <br /> Sundays and legai holidays. <br /> Subd.4. Procedure when data is not accurate or comptete. An individual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise chis rieht,an individual shall noafy in wricing the responsible authoriry d�scribing the na[ure of the disagreemeac. <br /> The responsib(e authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy past recipiencs of <br /> inaccurate or incomplete daca, including recipients named by [he individual; or(b)notify the individual that he believes che data to be correct. Data <br /> in dispu[e shall be disctosed only if the individual's statzmen[of disagreement is included with the disclosed data. <br /> The determinarion of the responsible auchoriry may be appeated pursuant[o the provisions of the admuustradve procedure act reladng to <br /> conresced cases. <br /> DATA PRIVACY AD�'ISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data", we would li..►ce to inform you that your request <br /> for a permit or license from the Ciry of Orono or any of its deparcments may require you to furnish certain private or <br /> confidencial information. <br /> You are notified that: � <br /> 1. The information you fumish will be used to determine your qualification fo:che permi[or license requested. <br /> 2 You may refuse to supply data, but refusal may require that the City deny the perm.it or license. <br /> 3. The information may be shared wich other local, state or federal agencies to the extent necessary to process <br /> the pemut or license. <br /> 4. If your requested permit or license requ'tres Councii action to approve, some information may become <br /> public. <br /> 5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. <br /> 6. Your fu11 name is required to process this applica[ion or permit. <br /> .�2s v��� -���^�� � ' �� �� <br /> First �Siddle Lasc <br /> �73 3 YYI�IYt� 1�9v�� ��e� �/ � <br /> Address �����/%/�� . <br /> � r� �' �� ( l��I h � � <br /> Ciry State Zip Phoae <br /> I understand my righcs as stated above. <br /> Signantre <br />