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. Sec.13.04 RIGHTS OF S[JB.TECTS OF DaTA ' <br /> Subd. 1. Type of data. The righcs of iadividual on whom che data is srorcd or to be sco�sd shall be as set forth ia this section. <br /> Subd.2. Information reqtrired to be given individual. �1n individua!asked to supply privatt at confidenrial data concerniag himself shall <br /> be informed of: (a)[he purpose and incended use of the rzquured dam wi[hin the collecang state ageacy,polidcal subdivision,or staccwide rystem; <br /> (b)wh:�k:er he may refuse or is.legally requir.d to supply che r:quesud data;{c)aay Iatown coasequence arising from his supplying or refusing to supply <br /> private or conndenaal data;and(d)che ideadry of ocher persoas or enddes authorizcd by sc�[e or federal law to rcceive tfie data. 'Ihis requirement shall <br /> not apply when an individual is asked to supply iavesd¢arive dam,pursuanc to secdon 13.82,subdivision 5, w a law enfoczemenc o�cer. <br /> 'I�e cemmissioner of revenue mav olace the nodc- rauired und:r�his subdivision in the individual income tax or oropem az refund <br /> inscrucuons inscezd of on chose forms. <br /> Subd. 3. Access to data by individual. Upon rcquesc to a responsible authoriry,an individual shall be informed whather he is che subjecc <br /> of stored daca on individuals,and whecher it is classifi:d as public, priva[e or confidenrial. Upon his funher requesc,aa individual who is the subjecc <br /> of stottd private or public data on individuals shall be shown[he dara wi[hout any charge to him and,-if he desires, shall be informed of the contenc <br /> and meaning of chat data. After an individual has been shown[he privace dara and informed of ics meaning,the dara need not ba disclosed ro him for <br /> siz monciu thereafrer unless a dispute or acaon pursuanc to this secdon is pending or addiriooal dara on the individual has been colleccPd or crea�ed. <br /> 'Ihe cesponsible au�t:oriry shall provide copies of the privace or public data upon request by the individua!subject of the data. The responsible authoriry <br /> may require the requesdng person to pay the actual costt o[makinz,cerdEying,and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, wi[h aay request made pursuant to chis subdivision,or within five days of <br /> the dace of the request,exctuding 5an►rdays,Sundays and leg�l holidays,if immediate compliance is not possible. If he cannot comply with the requesc <br /> wichin that ame,he shall so inform the individuai,and may have an addidonal five days wi[hin wtuch to comply wich the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data i�not accurate or complete. An individual may concest the accuracy or completeness of public or priva[e <br /> dara conceming himself. To exercise�his right,an individual shall noafy in wriang the responsible au[horiry describing the nature of the disagceemeot. <br /> The responsible authoriry shalt within 30 days eitt:cr: (a)correct the data found to be inaccurdte or incomptece and attempt to nodfy Qast recipiencs of <br /> inaccurate or incomple�e data, including recipiena named by che individual; or(b)no[ify the individual that he believes the dam to be correcG Data <br /> in dispuce shalt be disclosed only if the individual's statemenc of disagreement is inc(uded with[he disclosed data. <br /> The decerminadon of thc responsibiz au�horiry may be appealed pursuant to the provisions of the administrarive procedure act relacing to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri�hcs of subjects of data", we would like to inform you tha[your request <br /> for a permit or license from the Ciry of Orono or any of its departments may require you to fumish certain private or <br /> confidential information. <br /> You aze notified that: <br /> 1. The information you furnish will be used to detemune your qualification for the permit or license requested. <br /> 2. You may refuse to suppty data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with o�her local, state or federal a�encies to the ettent necessary to process <br /> the pernut or license. <br /> 4. If your reques[ed perm.it 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 on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> ,�� l(i �4`l� 1 �l'"~ / 1 /L ��� �� �yv <br /> Fir�t�� �o �% j� /�1 � �fiddle Last <br /> 1 t��d'�C <br /> Addresi /( /(C�. �/� 2 � � y 1 { �J b '/ . <br /> � t��( 7 � � j � �l <br /> �iry Sa�e Zip Phone <br /> I unders d my ri s. ted above. <br /> ���- ` ' �z z � __ <br /> s�g�N« <br />