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Scc.13.04 R[GI[TS OI�SUBJECTS OF UATA � <br /> Subd. I. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> 3ubd.2. Infonnation required to be given individual. An individual asked to supply private orcontidential data concerning himselfshall be <br /> informed of. (a)the purpose and intended use of the requested dala within the col lecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or conl'idential data;and(d)the identity of other persons or entities authorized by s�ate or federal law to rcceive the data.This requirement shal I <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision S,to a law enforcement ott�icer. <br /> "1'he commissioner of revenue may�ace the notice required under this subdivision in the individual income tax or property tax refund <br /> instruc[ions instead of on those tonns. <br /> SuUd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whe[her he is die subject of <br /> stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is dte subject of <br /> 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 content and <br /> meaning of tliat data. After an individual has been shown the private data and informed of its mcaning the data need not be disclosed to him for si� <br /> months thereafler unless a dispute or action pursuant to[his section is pending or additional data on the individual has been collected or created. The <br /> responsib�c authority shall providc copies oflhe private or public data upon request by[he individual subject ofthe data. The responsible authority <br /> may require the requcsting person lo pay the actual costs of making,certifying,and compiling thc copies. <br /> The responsible authority shall comply immedia[ely,if possible,with any rcqucst made pursuant to this subdivision,or within tive days of <br /> the date of the rcquest,excluding Saturdays,Sundays and legal holidays,if immediate compl iance is not possible. If he cannot comply with thc request <br /> within that time,he shall so inlorm the individual,and may have an additional tive days within which to comply with the request,eacluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accuratc or complele. An individual may contest the accuracy or completeness of public or private data <br /> concerning himself. To exercise this�ight,an individual shall notity in writing Uie responsible authority describing the nature ofthe disagreemenL 7�he <br /> responsible authority sha�l within 30 days either (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipients namcd by the indfvidual;or(b)notify the individual that he believes the data to be correcL Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions ofthe administrative procedurc acl relating to <br /> contested cases. <br /> DATA PRiVACY ADVISORY <br /> ln accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to infomi you that your request <br /> for a permit or license from the City of Orono or any of its departments may rcquire you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> l. The information you furnish will be used to detennine your qualification for the pennit or license <br /> 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 <br /> process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve,some infonnation 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 /> ���..��u.�, F��v ��5, t��.�'G.`S� <br /> First Middle Lasf <br /> Z 2 S� `z-J`Vv�,V�U.,� �Cy. <br /> Address <br /> 2�t� /lsz �r'�� .SSI j � l�S-/-�7�— 1 q G�; <br /> City State `l,ip Phonc <br /> I understand my rights as stated above. <br /> � <br /> �� <br /> Sign e <br /> Reset Form 32 <br />