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r� <br /> ti <br /> . ' <br /> Sec.13.04 RIGATS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secaon. <br /> Subd.2. Informaaon required to be given indiridual. An individual asked to supply private or co�dentiai data conceming himself <br /> shall be informed of: (a)the purpose and in[ended use of the requested data wi[hin the collecting state agency,poliacai subdivision,or sratewide <br /> rystem;(b)whe[her he may refuse or is legally required to supply the requesud data;(c)any lrnown consequence arising from tus supplying or <br /> refiuing tn supply private or confidential dara;and(d)the identiry of other persons or enades authorized by srate or federal law to receive the dara. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> '[lie commissioner of revernte mav olace the no'ce rewired under this��bdivi ion in the individual income ta.�or orocertv tax refund <br /> insnvctions mstead of on those forms. <br /> Subd.3. Access to data by individual. Upon request W a responsible authoriry,an individual shall be informed whether he is the <br /> subject of stored data on individuals,and whether it is classified as pubiic,private or confidential. Upon his further request,aa individual who <br /> is the subject of srored private or public data on individuals shall be shown the data wirhout any charge ro him and,if he desires,shall be informed <br /> of the content and meanin�of that data. After an individual has been shown the private data and informed of its meaaing,the data need not be <br /> disclosed to him for six months thereafrer unless a dispute or acaon punvant to dvs secrion is pending or addidonal data on the individual has been <br /> collected or created. The respoasible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. <br /> The responsible auchoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> Tha responsible authoriry shall comply immediately,if possible,with any request made pursuant to chis subdivision,or wirhin five days <br /> of the dace of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with <br /> the request within that time, he shall so inform the individual,and may have an addidonal five days within which to comply with the request, <br /> excluding Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or campleteness of public or <br /> private data concerning tiimself. To exercise dus right,an individual shall aotify in writing the responsibk authoriry describing the tiature of the <br /> disagreement. The responsible authoriry shall within 30 days ei�er. (a)correct the dara found w be inaccurate or incomplete and attempt to noafy <br /> past recipiencs of inaccurate or incomple�e data,including recipienu named by the individual;or(b)noafy the individual that he believes the dara <br /> to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The detemunation of the responsible authoriry may be appealed pursuant to the provisions of the adminis�arive procedure act relating <br /> to contested cases. <br /> PATA PRIVACY ADVI ORY <br /> In accordance with h1.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the �ity of Orono or any of its departments may require you to furnish certain <br /> private or 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 <br /> 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 shazed with other local, state or federal agencies to the eztent necessary to <br /> process 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 /> First Middle �i <br /> Address <br /> C��' State Zip Phone <br /> I understand my riehts as stated above. <br /> Signature � <br /> 4 <br /> 6 <br />