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Sec.13.04 RIGA'TS OF SLJB.TECTS OF D�1TA <br /> Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himseif shall <br /> be informed of: (a)the purpose and intended use of the requested dara within the collecting'state agency,polidcal subdivision,or sratewide system; <br /> (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply <br /> privace or confidenrial data;and(d)the idenriry of other perso�s or enrities authorized by state or federal law to receive the data. This requiremenc shall <br /> not apply when an individuai is asked to supply invesrigaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of re�enue mav place the noace reauired under this subdivision in the individua] income tax or propertv tax refund <br /> instructions inscead of on those forms. <br /> Subd. 3. Access to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whether it is classiFed as public, priva[e or confidenaal. Upon his further request,an individual who is the subject <br /> of stored private or public data on individuals shall be shown che data wirhout any charge to hun and, if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the privace data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acrion pursuant to [his secdon is pending or addidonal data on the individuai 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 authority <br /> may require the requesting person to pay the acrual cos�s of making, certifying,and compiling the copies. <br /> The responsible au[horiry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,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 Sarurdays, <br /> 3undays 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 conceming himself. To exercise this rieht,an individual shall nodfy in wriang the responsible authoriry describing�he narure of the disagreement. <br /> The responsibte authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of <br /> inaccurate or incomplete data, including recipiencs named by[he individual; or(b)notify the individual[hat he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the administnrive procedure act relaring to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we wouid 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 are notified that: <br /> 1. The information you fumish will be used to determine your qualification for the pemut 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 agencies to the extent necessary to process <br /> the pernut 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 /> (. Your full name is required to process this application or permit. <br /> ��v��t,v �� ��` �(JL Z <br /> First / Middle Last <br /> � t ��' `� l �� 'E� S i P �LL� 'P ` �. U r� <br /> k <br /> Address � � � �� �/ �J��� ] /��� �� � � <br /> /1,� G� �� � n ���'V, � 7 - <br /> Ciry Stare Zip Phone <br /> I understand m rights stated above. j <br /> � � <br /> � <br /> Signature <br />