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�Sec.1.3.U4 RIGHTS OF SUBJECTS OF DATA <br /> Subd_ 1. Tti•pe of data. The rights of indi��idual on�vhom t�ie data is stored or to be stored s6a11 be as set forth in this section. <br /> Subd.2. Information requn�ed to be given individuaL An indi�-idual asked to supply private or contidential data concerning}rimself shall Ue <br /> informed uf: (a)the ptnpose an�i intended use of the requesteJ data�vithin the cuilecting state ugency,political sutxiivisiun,or statev�ide system;(U) <br /> whether he may reYuse or is leg�il(y required to�upply the requc�ted dxta;(c j uny kno�vn cunseyuence tuising fivm his supplying or refiwing to supply <br /> private ot confidential data;and(d)the identity of other persons ot eutr[ies authorized by state or federal lac��to recei��e the data. Thls requitement shall <br /> not applv��hen an indi��idual is asked tn supply inves[igati���data,pucsuant to section 13 82,subdivision 5,to a law enforcement otlicer. <br /> The conuiissioner uf revenue mav olaee the notice reauired uncler this subdivision in the individual income taa ui_pi'ODeitv tax refund <br /> insiructions insteud of on thvse forms. <br /> Subd.3. Access[o data by indi��iduai. Upon request to a responsible authority,an utdividua(shall be informed�vhether he is the subject of <br /> storeci Sata on individuals,and w}iether it is classitied as public,private or conYidential. Upon}vs T'wtlier request,an individual�vho is the suUject oY' <br /> stored private or public ciata on individuals shall be shown the data withuut anq ch:irge tu him and,ifhe desires,shall Ue infuimed of the content;znd <br /> mesuiing of thut duta. After an inclividual has been sho�vn the private datn and infvimed of its menning.the ciata need not be disclused to him for sia <br /> months thereafter unless a dispute or actiun pursuant[o this section is pending or additional data un the individual has been collected or created. The <br /> responsible authorin�shall provide copies of the priv2te or public d2ta upc�n request by the individual subject of the data. The tesponsible authority <br /> may require the requestii�peison to pa} the actual costs ofmaking,cettifying,and compi(ing the wpies. <br /> The res��onsible authorit}'shall comply ucuneciiately,ifpossible,w�ith any request made putsuant to this subdivisiun,or Hithin Yive days of <br /> the ciute of the request,excluding Saturdays,Sundays�nd legal holiciuys_if icnmediate compliance is not pua�ible. If he cunnd comply tvith the request <br /> ���itlun that time,he shall so infonn the v�di��idual,and may have au additiunal five days v�ithui�vhich to complV Nifli[he request,excluding Saturdays, <br /> Sundays and legal holidays <br /> Subd.4. I'��ocedm�e��hen data is not accwate or complete. An inJividual may contest the acctuacy or completeness oCpuUlic or pri��ate ciata <br /> con�erning himself. To exercise this right,un individual sha12 notitj�in wiiting the responsiUle authoiity desciiUing the nnhu�e oY the clisagreement. The <br /> responsible authority shall within 30 da}�s either: (a)conect the data Yound to be inaccurate ur iucomplete and attempt[o noti'ty past recipieuts uf <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the indi�7dua1 that he believes the data to be conect. Data in <br /> dispute shall be disclosed onl}�if the individuaPs statc.ycnent of disagreement is included�uith the disclosed data. <br /> T1ie detemunation of the responsible authority may be appealecl p�u�suant to the provisions of the administrative procedure act relating to <br /> contesfed c:ases. <br /> DATA PRIVACY ADVI50RY <br /> In accordanee with M.S. 13.04,Subd.2,"Rights of subj ects of data",we would like to informyou thatyour 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 are norified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit 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 federai 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 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 ful] name is required to process this application or permit. <br /> First Middle Last <br /> ��---� ��� �� ��}r�� �� <br /> naa�ss <br /> I Z� � �'1 lS`-..��`�(Pf r .I��I�� <br /> City C-� ��,��"��� }� � State ��� �� ZiP _���ii�` Phoee � CN 3 � ��cl�' " <br /> /�✓ <br /> I understand my rights as stated above. <br /> I�-1 ,�".S�' <br /> �. u C,�-�"� -}~� %�"�%�/�.. <br /> Signature <br /> Reset Form 32 <br />