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� � <br /> i � <br /> Sec.13.04 RIGHTS OF SLTB.TECTS OF DATA <br /> Subd. 1. Type o[data. 'Ihe righ[s of individual on whom the data is stored or oo be stoced shall be as set for[h in[his section. <br /> Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidential data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the csques�ed data within the collecdng Etate agency.poliacal subdivision,or statewide sysum; <br /> (b)whether he may refuse oY is tegally required to supply the requested data:(c)any lmown consequence arising from ius suppiying or refvsing to supply <br /> private or coafidentiai data;and(d)the identi�y of other persoas or enrides authorized by state or federal law to ceeeive the data. This requirement shall <br /> not appty whea an individual is asked w sapply invesngadve daa,putsuanc oo secdon 13.82,subdivision S,to a law enforcement officer. <br /> The commissioner of revenue mav olace the nodce rewiced under this subdivision���h�individual income tax or prooenv tax refund <br /> inscrucaons insuad of on those forms. ' � � <br /> Subd.3. Access to data by individual. Upon m�uesc to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of soored data on individuals,and whe[her it is class�ed as public,private or confideaoal. Upon his further requesc,an individual who is the subject <br /> of swred private or public data on individuals shall be shown the data wirhouE any charge to him a,nd:if he desins,shall be informed of the content <br /> a�meaning of that data. Afur an individual has been shown the private data and informed of iu meaning,the data need not be disclosed Lo him for <br /> six months thereafter untess a dispute or acdon pursuanc to this secaon is pendiag or addiaonai data on the individual has been collecud or created. <br /> The tespoasible authodty shall provide copies of the private oc public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesdng person to pay the actual cos[s of making,certifying,and comp�7'ing the copies. <br /> The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or wi[hin five days of <br /> the date of the requesG excluding Saturdays,Sundays and legal halidays,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 addiaonal five days witt►in which w comply with the request,excluding Saturdays, <br /> Sundays amd lega(holidays. , ' <br /> Subd.4. Procedure when data is net accurate or compiete. An indivisival may contest the accuracy or compieteness of public or private <br /> data concerning himself. To exercise this right,an individual s6all noafy in wriang the responsible authority descn'bing the nature of the disagreemenc. <br /> The responsible authoriry shall withia 30 days'either. (a)correct the data found ro be inaccurau or incomptete and suempt w nodfy past ncipientc of <br /> inaccucate or incomplete data,including recipients named by the individual;or(b)noafy the individual that he bdieves the data to be corcect Data <br /> in dispuce shall be disclosed only if the individual's staument of disagreement is included with the disclosed dara. <br /> The determination of the responsible authoriry may be appealed pursuanc co the provisiqns of the administtadve proceduro act celating 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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confideatial information. <br /> You are notified that: <br /> 1, The infonnation 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 Ciry 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 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 full name is required to process this application or permit. <br /> �S 1'�1s�! aMA[o n� <br /> Firsc /n d /`� / �D�/ Middle �� �� 1-� — <br /> � h <br /> �d���,�� L�.� a�,�►� �s3� z �a� 'Ss"y.� �- <br /> City Stace Z�p Phone <br /> I understand ' ts stated above. <br /> Signature <br />