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- <br /> Sec.13.04 RIGHTS OF SLIBJECTS OF DATA <br /> Subd. 1. Type of data. "Ihe righcs of individual on whom rhe dara is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply privace or confidendal data concerning himself shall <br /> be informed of: (a)the purpose and in[e�ded use of the requested data wi[hin the collecdng'statB agency,polidcal subdivision,or statewide rystem; <br /> (b)whether he may refuse oY is legally required to supply the requested data:(c)any known consequence arisiag from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idenory of other persons or endaes authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesdgarive dara,pursuant to secaon 13.82,subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the nodce reouired under this subdivision in the individual income rax or propertv raz refund <br /> inscrucdons instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whe[her it is class�ed as public, private or confidendal. Upon his further request,an individual who is the subjecc <br /> of stored private or public data on individuals shall be shown the data without any charge to him and,-if he desires, shall be informed of the contenc <br /> and meaning of that data. Afrer an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to hun for <br /> six months thereafter unless a dispuu or accion pursuant to this secdon is pending or addidonal dan on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesting peraon to pay the actual coscs of making, certifying,and compiling the copies. <br /> The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision,or wi[hin five days of <br /> the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legai holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeness of public or pri�•ate <br /> data concerning himself. To exercise this right,an individual shall nodfy in wridng[he responsible authoriry describing the nature of the disagreement. <br /> T'he responsible authoriry shall within 30 days either: (a)correct the data found to be inaccu�ate or incomplete and attempt to noafy past recipienu of <br /> inaccurate or incomplete data, inciuding recipients named by the individual;or(b)noafy the individual thac he believes the data to be coaect. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disc(osed data. <br /> The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the admirustradve procedure act reladng to <br /> contested 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 permit 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 aze 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 City deny the permit or license. <br /> 3. The informa[ion may be shared with other local, 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 /> 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 permit. <br /> � ( �, , , �"_ <br /> �,��1 �cbR 2 � ��1�+.�b� �L�, r � <br /> First Mid Last <br /> I`4' �;� � ���, 1\� � �,> > � �� <br /> Address � ,\ Z <br /> � � 7 <br /> ` T <br /> � �+.��c,s ,L���a ' �'l�n� ��C �,�,� > � �� 7 <br /> Ciry Snte Ztp Phone <br /> I understan� my rights as stated above. <br /> i � ' <br /> _-������-�- � ��9-A - <br /> Signacure <br />