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r <br /> Sec.13.04 RIGHTS OF S[JB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidendal data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the requested dara wi[hin the collecang'state agency, polidcal subdivision,or sratewide system; <br /> (b)whether he may refuse ot is legally required to supply[he requested data;(c)any known consequence arising from his suppiying or refusing ro supply <br /> private or confidendal data;and(d)the idendry of other persons or enrides authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesrigadve dara,gursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the noace re4uired under this subdivision in the individual income tax or prooertv rax refund <br /> instrucdons instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whe[her it is classified as public,private or confidential. Upon his further request,an individual who is the subject <br /> of stored private or public data on individuals shall be shown the dara wi[hout any charge to him and,-if he desires,shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the dara need not be disclosed to him for <br /> six months thereafter uniess a dispute or acdon pursuant to this secrion is pending or addidoaal darn on the individual has been collected or created. <br /> The responsible authority 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 actual cosu of making, certifying,and compiling ihe copies. <br /> The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Sacurdays,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 Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or pri�•ate <br /> data concerning himself. To exercise chis right,an individual shall nodfy in wridng the responsible aurhoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to nonfy past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual thac he believes the data to be coaect. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuanc to the provisions of the adminis�adve procedure act reladng to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request <br /> for a pemut or license from the Ciry 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 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 ocher local, state or federal agencies to the extent necessary to process <br /> the pemut 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 full name is required to process this application or permit. <br /> �' � � � � ' �f���� �� � <br /> >� �� � � ,G� gY <br /> First Middle Last <br /> � � S /Iiod-�i l�� �� �7 <br /> Address ��C��7, � ���-' � / / '' �� �.L <br /> c.� /��i �I <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> �� <br /> Signamre <br />