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, r <br /> � Sec.13.04 RIGHTS OF SUBJECTS OF DATA � <br /> Subd.1. Type of data. The rights of indlvidual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Intormation required to be given individual. An individual asked to supply private or contidential data concerning himself shall be <br /> informed of: (a)the purpose and intended use of the requested data within the collecting state agency,potiticai subdivision,or statewide system;(b) <br /> whether he may refuse or is legatly required to supply the requested data;{c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity of other persons or entities authorized by state or federal lavv to receive the datn. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement offlicer. <br /> The commissioner of revenue mav alace the notice required under this subdivision in the individual income tux or orooertv tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsibie authority,an individual shall be informed whether he is the subJect of <br /> stored data on individuals,and whether it is classi�ed as publlc,private or confldential. Upon his further request,an individual who is the subJect of <br /> stored private or public data on individuals shall be shown the data without any charge to him and,If he desires,shall be informed of the content and <br /> meaning of that data. After an individual has been shown the private data and Informed of its meaning,the data need not be disclosed to him for six <br /> months thereafker unless a dispute or action pursuant to this section is pending or additional data on the individual has been coilected or created. The <br /> responsible author(ty shull provide coptes of the private or public data upon request by the individual subject of the data. The responsible authority muy <br /> require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authority shall compiy immediately,if possible,with any request made pursuant to this subdivision,or within five days of the _ <br /> - — ._ _ _ . _.. <br /> date of the request,excluding Saturdays,5undays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within <br /> that ttme;he shall so inform the individual,and may have an additional�ve days within which to comply with the request,excluding Saturdays,Sundays <br /> and legal holidays. <br /> Subd.4. Procedurc when dnta is not sccurate or complete. An Individual may contest the accuraey or completeness of public or private data <br /> concerning himscif. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The <br /> responsible suthority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipiehts named by the individual;or(b)notify the indivldual that he bclieves the data to be correcG Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed dsta. <br /> The determination of the responsible authority may be appealed pursuunt to the provisions of the administrative procedure act relating 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 /> 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 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 /> � ` ��e -��-- <br /> First Midd e L st <br /> �7 3 � � ���► o K -� - , <br /> Address <br /> � , �1 , s53�s 9s�-93�- 39�0 <br /> City State Zip Phone <br /> I understand my rights as stated abo . <br /> � <br /> �------- _...._-' _..___ ------- ----- _ <br /> _ --- <br /> __. <br /> _--- - — <br /> �, __.___.. _ <br />/�'' -- --- ------ <br />�_--- ignature " - <br />