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,> � <br /> Sec.13.04 RIGHTS OF SUSJECTS OF DaT� <br /> Subd. 1. Type of data. The righa of individual on whom the dara is stored or to be stored shall be as set fonh in rhis secrion. <br /> Subd.?. Informatioo reqirired to be given individual. An individual asked to supply private or confidendal data concerning hunself shall <br /> be informed of: (a) the purpose and in[ended use of the requested dara within the collecting"state agency, political subdivision,or sratewide system; <br />�b)whether he may refuse oY is legally required to supply the requesced data;(c)any lrnown consequence arising from his supplying or refusing to supply <br /> private or confidencial data;and(d)che identiry of ocher persons or enrides au�horized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesriearive dara, pursuanc ro secrion 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav plac the nonce rauired under this subdivision in the individual income tax or propertv tax refund <br /> instructions insread of on those forms. <br /> Subd. 3. Access to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject <br /> of stored data on individuals, and whe[her it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject <br /> of stored private or pubiic data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content <br /> and meaning of[hat data. Aftzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for <br /> six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been coilected 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 authoriry <br /> may require[he requesting person to pay the acmal costs of makine, cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or within five days of <br /> the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the reques[ <br /> within that time,he shall so inform[he individual,and may have an addirional five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Pracedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or pri�•ate <br /> data concerning himself. To exercise rhis right,an individual shall noafy in writing the responsible authoriry describing rhe nature of the disagreemeat. <br /> The responsible authoriry shall within 30 days ei[her: (a)correct the data found to be inaccura[e or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreemenc is included with the disclosed data. <br /> Tlie de[ermina[ion of�he rzsponsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Riahts of subjects of data", we would 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 furnish will be used to detemune 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 pernut or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> public. <br /> j. 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 /> f�U�L�`�`" r` i l� ) �L S��J <br /> First . �fiddlz Lasc <br /> �I��P ��1�f t�f-F ukX�I�J ��� <br /> Address <br /> l�1�10`,� �r� ���i � �5 3C0'-� �7�� �5��� <br /> City State Z�p Phone <br /> I understand y rights as stated above. <br /> , <br /> � <br /> � �� �,���-- <br /> Signature <br />