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. , <br /> Sec.13.Q4 RIGFTfS OF SLJB,fECTS OF DaTa ' <br /> Sutd. 1. Type of data, The righ�s of individual on whom�he dam is sroced or to be scored shall be as set forth in this sccaon. <br /> Subd.2. IntormaQon reqirired to be given indiYidual. ?.n individual asked W supply priva[e or confidendaI dara concerniag himself shal! <br /> be infora:cd o,`: (a) the purpose aad incended use of the czqucssed dara within the collecang State agency,polidcal subdivision,or sacewide rysum; <br /> (b)whe4':et he rray rsfuse or is_legalIy requir.d to supply che rqucsud data;(c)any Iaiown coasequence arisiag from his suppiying or refusing to supply <br /> privace or connder.da!data;ar.d(d)the idendry of other persoas or encides auchocizcd by state or federal law ro rcceive tfie daca. 'Ihis requiremenc shall <br /> noc apply when an ir:dividuaI is asked to supply invesdgadve daa,pursuanc ro secdoa 13.82,subdivuion 5, �o a law enforcemenc officer. <br /> 'I;�e eer.imissioner of rcvenue mav vlac� che nodc- rauired und-r this subdivision in the individual income rax or orooem raz refund <br /> instrucdons inscezd of on chose forms. <br /> Subd.3. Access to data by individual. Upon requcsc to a responsible authority,an individual shall be informed whccher he is che subjecc <br /> of stor:d da[a on individuals,aad whether ic is ctassiFi:d as public,privace or confidenaal. Upon his further r.quest,aa iadividual who is the subje:c <br /> of stored Qrivace or public dam on individuals shall be shovm che dara wichouc any charge to him and;if he desires,shall be informed of the eoncanc <br /> ar.d meaning of that dara. Aher an individual has been shown[he priva�e dac�and informed of ics meaning,the dara ne:d not be d'uclosed ro him for <br /> siz mondu thereafter uniess a dispute or acaon pursuant to this secdon is pending or addidooal dan on the individual has been collecced or ereacrd. <br /> Tne respocuibla au[horiry shall providt copies of che privacr or pubfic data upon tequest by the individual subject oF che data. Tha responsible authociry <br /> may require �he requesring person to pay che accual coscs oi making, cerdfying,and compiling the copies. <br /> The responsible auchoriry shall comply immediately,if possible,wi�h aay requesc made pur5uant to this subdivision,or wichin five days of <br /> the date of the request,ezcluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc <br /> wichin that dme,he shall so inform the individual,and may have an addidooal five days wichin which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data i�not accurate or complete. An ir.dividual may contest the accuracy or completeness of public or private <br /> dara conceming himself. To exercise this right,an individual shall noafy in wricing[he responsible auchoriry describing the nature of the disagreemenc. <br /> The responsible au�horiry shall within 30 days ei�t;er: (a)correct[ha data found to be inaccurace or incompiete and aaempc to nadfy pasc recipien�s oF <br /> inaccurste or incomple�e data, including recipien�s named by [he individual:or(b)nodfy the individual thac he believes che dact to 6e correct Data <br /> in dispuce shal(be disclosed only if the individual's sta�ement of disagreem:nt is inctuded wi�h the disclosed data. <br /> The decerminaaon of the responsibla au�horiry may be appealed pursuant to the provisions of tha adminisaarive procedure act relaang to <br /> contesud cases. • <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri;hts 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. Zhe information you furnish will be used to decermine your qualification for[he permi[or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or licease. <br /> 3. The information may be shared with ocher local, stace or federal agencies to the e�tent 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 ri�hts under M.S. 13.04 (available upon request) to review private data onyourself. <br /> 6. Your full name is required to process this application or permit. <br /> J �l j � �v (,�L�j C��� �(�t,(J� C�'��+vrs � <br /> Firsc �� � �fiddle I.asc <br /> �'�� 1 6'��.Z�� ��v� S � �U � <br /> Add u <br /> !'�l�.��'✓� i ;�_�,'f�-� o�����- ��Z��� C� � 2 -�'g �.�� Z <br /> Ciry Sate Zip Phaae <br /> I understand my ri;hts as stated above. <br /> , � � � . <br /> /VV'y� !�. � 10(�--Q� <br /> ' gnacure <br />