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Sec.13.04 RIGHTS OF SUBJECTS OF DaT� <br /> Subd. 1. Type of data. The righcs of individual on whom the data is stored or co be stored shall be as set forth in this secdon. <br /> Subd..'.. Information reqirired to be given individual. P.n individuai asked to supply private or confidendal data conceming hicnself shall <br /> be informed of: (a)the purpose and intended use of the requesied data withia the collecting'state agency,polidcal subdivision,or sratewide system; <br /> (b)whether he may refuse oY is legaily required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the iden[ity of other perso�s or entities authorized by state or federal law to receive the data. This requiremeot shall <br /> not apply when an individual is asked to supply invesdeaave dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav place the noace reauired under this subdivision in the individuai income tax or propercv tax refund <br /> instruc[ions instead of on those forms. <br /> Subd. 3. Access to data by indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject <br /> of scored data on individuals, and whe[her it is classified as public, privace or confidencial. Upon his fur[her request, an individual who is[he 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 content <br /> and meaning of[hat data. Aftzr an individuai has been shown the private data and informed of ics meaning, the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acrion pursuant to this secrion is ptnding or addiaonal data on the individual has been collected or crea[ed. <br /> The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry <br /> may require the requesting person to pay the actual coscs of making, certifying; and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of <br /> the date of the request,exctuding Sa[urdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy with the request <br /> within that time,he shall so inform[he individual,and may have an addiaonal five days within which to comply with the request,excluding Sarurdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individuat may contest the accuracy or completeness of public or pri��ate <br /> data conceming himself. To exercise this right,an individual shall nodfy in writing the responsibie authoriry describing[he nature of the disagreement. <br /> The responsible authoriry shall within 30 days eithec (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of <br /> inaccurate or incomplete data, including recipien[s named by the individual; or(b)notify the individual thac he believes the data to be correc[. Data <br /> in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. <br /> The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act rela[ing to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Riabts 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 fumish 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 City 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 pernut or license. <br /> 4. If your requested pemut or license requires Councii 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 permit. <br /> �.�ti�n I.�i Ls U 120�.i�l V f�GC L.���C <br /> First �Siddle Last <br /> '��`��5 �,� � �. � � <br /> Address <br /> �' il,) �j �y`CJ cS 7L.j�L,�.s���'��c��-z <br /> .3�,i.�c-�t2'�Ctc[] , <br /> Ciry State Zip Phone <br /> I understand my ri state above <br /> ,"�� _—��� <br /> Signature <br />