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Sec.13.04 RIGHTSOFSUBJECTSOFDATA <br /> Subdivision 1. Type ojdata. The rights of individual on whom the data is stored or to be stored shall be as set forth in thrs sec7ton. <br /> , <br /> Subd.2. Injormatian required to be given individuaL An rndividual asked to supply private or confidential data concerning himself <br /> shalf be informed of.� (a)the purpose and rntended use ojthe requested data wrthrn the collecting stale agency,polrtical subdrvrsron,or slatewide <br /> system;(b)whether he may refuse or is legally required to supp/y the requested data;(cJ any known consequence arising from his supplying or <br /> refusing to supp/y private or confrdential data;and(d)the identrty of other persons or entitres authorized by state orfederal law to receive 1he data. <br /> This requirement shall not apply when an indivrdual is asked to supply investigative data,pursuant to section 13.82, subdrvision 5, to a lmv <br /> enjorcement o�cer. <br /> The commissioner of revenue may place the notice required under thrs subdrvrsion in the indivrdual rncome tax or property tax refund <br /> instructions instead oJon those forms. <br /> Subd.3.Access to dala by individuaL Upon request to a responsible authority,an indivrdual shall be informed whether he rs the subject <br /> ojstored data on individuals, and whether rt rs classified as public,private or confrdentral. Upon his further request,an individual who rs the <br /> subject of slored private or public dala on indivrduals shal!be shoivn the data wrthou!any charge to him and, if he desires,shall be rnformed of <br /> the conten[and meaning of that data. After an individual has been shotivn 1he private data and informed of its meanrng, the data need nol be <br /> disclosed to him jor six months thereafter unless a dispute or actron pursuant to this section is pending or additiona!data an the indivrdual has <br /> been collected or created. The responsible authority shall provrde copres of the private or public data upon request by the rndividua!subject oj <br /> t{�e data. The respansrble authorrty may requrre the requesting person to pay the actual costs of making,cer[rfying,and compiling the copies. <br /> The responsible authorrty sha/!comply immedrately,rfpossible,wrth any request made pursuant to this subdivisron,or tivithin five days <br /> of the date of Ihe request,excludrng Saturdays,Sundays and lega!holydays,if immediate compliance is not possible. Ijhe cannot comply with lhe <br /> request within that time,he shall so injorm the individual,and may have an additional frve days tivithrn which to comply wi[h the request,excluding <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accura[e or complete.An individual may contest the accuracy or completeness ofpublic or private <br /> data concerning himselj. To exercise thrs right, an individual shall notify in writing the responsible authority describrng the nature of the <br /> drsagreemenl. The responsible authorrty shall wrthrn 30 days either.• (a)correct the datajound to be inaccurate or incomplete and attempt to not� <br /> pasr recipients ojinaccurate or incomplete data,includrng recrpients named by the indrvidual;or(bJ notify the indrvrduaf that he belreves the data <br /> to be correct. Data in dispute shall be disclosed only rjthe rndividua!'s statement ojdisagreement rs included with the disclosed data. <br /> The determination oJthe responsible authoriry may be appealed pursuant to the provisrons of the adminrstrative procedure act relating <br /> to contested cases. <br /> DATA PRIVACYADVISORY <br /> In accordance wrth M S.13.04,Subd.2, "Rights ofsubjects ofdata",we would Irke to rnform you that yot�r request for a permit or license <br /> J�rom the City ojOrono or any of its departments may require you!o furnish certain private or confidential information. <br /> You are notifred that: <br /> 1. The information you furnish will be used to determine yo:�r qualrficatron jor the permit or license requested. <br /> 2. You may refuse to supply data,but refusal may requrre that 1he City deny the permit or license. <br /> 3. The rnformalion may be shared with other local,state or federa!agencies to the extent necessary to process the permit or <br /> license. <br /> 4. l,f}'aur requested permrt or license requires Councr!actron to approve,some information may become public. <br /> 5. You have certain rrghJs under M.S. 13.04(see folloiving page)to review prrvate dala on yourselj. <br /> 6. Your fu[!na»:e is required to process t{:is application or permit. <br /> PLEASE PRI,VT <br /> -��i� D � C�� �� <br /> First Middle Last <br /> �il� c,�;,�-�Ts � � l�p <br /> Address <br /> ����,�e�.►. M A-� 5�►7-, <br /> City State Zip Phane <br /> /und stan my ghts as stated above. <br /> ature <br /> 10 <br />