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.� � � > <br /> Sec.13.04 RIGHTS OF SL`BJECTS OF D?.T�1 <br /> Subd. 1. T}•pe of data. 'Ihe nghts of individual on whom�he data is stored or to be stored shall be as sec for[h in this secdoo. <br /> Subd. '_. Information required to be�ven indicidual. An individual asked to supply private or conhdendal data concerning himself shall <br /> be informed of: (a) the purpose and incended use of the requesred data wi[hin the collecting'stace agency, political subdivision,or sta[ewide rystem; <br /> (b)wheeher he may refuse or is Izgally required to supply�he requesced data:(c)any Imown consequence arising from his supptying or refusing[o supply <br /> private or confidennal data:and(d)[he idenoty ot ocher persons or enddes au[horized by state or federal law to receive the da[a. This requiremeat shall <br /> not apply when an individual is asked ro supply invesdgadve data, pursuan[to secdon 13.82, subdivision 5, ro a law eniorcemen[oificer. <br /> The com.missioner of re�erue r�av �lace ,he roric eauirPd under �his subdivision in che individual i.^.come taz or oropem taz ret"u^d <br /> instruc�ions inscead ot on those forms. <br /> Subd. 3. :�ccess to data by individual. lioon request to a responsible au�horiry,an individual shall be informed whether he is the suoject <br /> of stored data on individuals, and whecher i[is classitiui as puolic, pnvate or con2idennal. lipon his tur[her request, an individual who is rhe subject <br /> of stored pnva[e or public data on individuals shall be shown the da[a wichout any charee to hun and, if he desires, shall be informed of the content <br /> and meaning of tha[data. .�her an individual has been snown che priva[e data and informed of irs meaning, the data need not be disclosed to hun for <br /> six months [hereafter unless a dispute or acnon pursuanc to chis secaon is pending or addiaooal data on the individual has been collected or crea[ed. <br /> The responsible autnonry shall provide copies of the pm a�or public data upon request by the individual subject ot the data. The responsible auchori[y <br /> may require the requesting person to pay [he actual costs of making. cerrifying, and compiling the copies. <br /> The responsible aurhority shall comply immedia[ely, if possible, wirh any request made pursuant to this subdivision, or within five days of <br /> the date of the requesc, excluding Sa�urdays,Sundays and legal holidays,if immediate compliance is not oossible. If he cannoc comply wi[h[he reques� <br /> wi[hin that time,he shall so inform the individual,and may have an addidonal five days wichin which ro comply wich the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise[his neht,an individual shall notify in wnang the responsibte authonry describing[he nacure of the disagreement. <br /> The responsibfe auchoriry shall within�0 days ei[her. (a)correct the data found to be inaccurate or incomplete and a[temp[to nodfy past recipients of <br /> inaccurate or incomplete data, includine recipienu named by the individua(; or(b) nodfy the individual that he believes the data to be correct. Data <br /> in dispu[e shall be disctosed only if the individual's stacemen�of disagreemen[is included with [he disclosed data. <br /> The decermina[ion of the responsible au[honry may be appealed pursuan�to the provisions of the administradve procedure act relating to <br /> contested cases. <br /> D:�T:� PRIV:�CY ADVISORY <br /> In accordance wi[h M.S. 13.04, Subd. 2, "Riehts of suojects of data", we would like �o inform you thaC your request <br /> for a permit or license Trom the Ciry of Orono or any of i�s departments may require you to fumish certain pri��ate or <br /> confidential iniormation. <br /> `:'ou a:e rotified chat: <br /> 1, The information you furnish will be used[o decermine your qualification for the permit or license requested. <br /> 2. You may reTuse to supply da[a, but refusal may require that the Ciry deny the permit or license. <br /> �, The information may be shared wi[h 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 ro approve, some information may become <br /> public. <br /> j. You have certain rights under ti1.S. 13.04 (available upon request) to review private data on yourself. <br /> (. Your full name is required to process this applica�ion or permit. <br /> �l���Z., P.r�1 �� � _ '�:{�;`��_:j <br /> First `tiddle Last <br /> � <br /> a % <br /> ��y`; tS � N �, <br /> Address <br /> ��<C �l�� -- ;� �.�, <br /> �S `(�� � c �.(- l� z,� <br /> City Stare Zip Phone <br /> I unders[and my rights as stated above. <br /> ,� <br /> � � <br /> Signature <br /> / <br />