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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 shal!be as set forth in this section. <br /> Subd.2. Information required to be given individuaL An individua!asked to supply private or confdential data concerning himself <br /> shall be informed of. (a)!he purpose and rntended use of 1he requested data�vithin the collecting state agency,political subdivision,or statewide <br /> system;(b)whether he may refuse or is legally requrred lo supply Ihe requested data;(c)any known consequence arising from his supplying or <br /> refusing lo supply private or confrdential data;and(d)the identity of other persons or entitres authorized by state orfederal lmv to receive the data. <br /> This requirement shall not apply when an indrvidua!is asked to supply investigative data,pursuant to section 13.82, subdivision 5, to a Imv <br /> enforcement officer. <br /> The commissraner of revenue mav place the notice required under this subdivision in(he ittdivrdual income tax or Dropertv tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individuaL Upon request to a responsrble au�hority,an indrvidual shall be infarmed whether he is 1he subject <br /> ojstored data on indrvrduals, and whether it is classified as public,private or confidential. Upon his further request,an individual who rs the <br /> subject of stored private or public data on individuals shall be shotivn the data wrthout any charge lo hrm and,rf he desires,sha/1 be informed oJ <br /> the content and meaning of that data. After an rndrvidua!has been shotivn the prrvate data and informed of its meanrng, the data need not be <br /> disclosed to him for srx months thereafter unless a drspute or action pursuant to lhis section rs pending or addrtrona!data on the individual has <br /> been collected or created. The responsible authority sha/l provrde copies of the private or publrc data upon request by the rndividual subject of <br /> the data. The responsible authority may require the requesting person to pay the actua!costs of making,cerl�ing,and compiling the copies. <br /> The respansible authority shall comply immediately,ifpossible,with any request made pursuant to this subdivision,or within five days <br /> of the date of the request,excluding Saturdays,Sundays and lega/holydays,if immediate compliance is not possrble. Ijhe cannot comply�vith the <br /> request within that time,he shall so injorm the rndrvidual,and may have an additional five days tivithrn which to comply with the request,excluding <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete.An individual may contesl the accuracy or completeness ofpublrc orprivate <br /> data concerning himself. To exercise this right, an individual shall not�in writing the responsible authority describing the nature of the <br /> disagreement. The responsible authorrry shallwithrn 30 days either: (a)correct the datafound to be inaccurate or incomplete and attemp�to not� <br /> past recipients of inaccurate or incamplete data,rncluding recipients named by the rndrvidual;or(b)not�the indivrdual that he believes the data <br /> to be correcl. Data in dispute shall be disclosed only if the individual's sta�ement of disagreement is included with the disclosed data. <br /> The determination ojthe responsible authority may be appealed pursuant to!he provisions of the administrative procedure act relaling <br /> to contested cases. <br /> DATA PRIVACYADVISORY <br /> In accordance with M.S.13.04,Subd.2, 'Rights ofsubjects ojdata';we wouldlike to inform you thatyourrequestfor apermit orlrcense <br /> from the City of Orono or any of its departments may requrre you to furnish certain private or confidenlial informatron. <br /> You are notifred that: <br /> 1. The injarmation you furnish wi!/be used to de�ermine your qualification for the permit or/icense requested. <br /> 2. You may refuse to supply data, but refusal may reguire that the Ciry deny the permit or license. <br /> 3. The rnformation may be shared with other local,state or federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. 11 your requested permit or license requires Counci!action to approve,some information may become public. <br /> 5. You have certain rights under M.S. 13.04(see jolloiving page)to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> PLEASE PRINT <br /> � <br /> ����c����� A�ll��� ���������,� <br /> First Middle Last <br /> ��j 1N'< < I��;v L� ��. A> > <br /> Address <br /> L c.���� l�;z.I%F� Y�'� �� � `� 5� C� <br /> City � State Zip Phone <br /> I understand my rights as sla�pd aboXe. <br /> iC�`� ��, ,. <br /> ✓(.j%�L��L`!� �- ��,''�(,d-ti!�l <br /> Signatu�i � <br /> 10 <br />