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� . <br /> Sea13.04 RIGHTS OF SLJBJECTS OF DaTA <br /> Subd. 1. Tqpe of data. The righcc of individual on whom the data is stored or to be stored shall be as set focth in this secaon. <br /> Subd.2. Information reqiared to be�ven individual. An individual asked W supply private or confidendal dara conceming himself shall <br /> be informed of: (a)the purpose and iaunded use of the requested data within the collecting 3tate agency,poliacal subdivision,or statewide rysrem; <br /> (b)whe[her he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing w sappty <br /> private or confidendat data;and(d)the identiry of other persons or enaaes authorized by state or federal taw to receive the data. This requirement shall <br /> not apply when an individual is asl:ed to suppty invesdgadve data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The commissioner of rcvenuc mav place the noace required under this subdivision in the individual income tax or orapem tac refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whecher it is class�ed as public,private or confidenaal. Upon his further request,an individual who is the subject <br /> of stored prirate or public data on individuals shall be shown the data without any charge to him and;if he desires,shall be infocmed of the content <br /> and meaning of ct►at data. After an individual has been shown che privau data and informed of ics meaning,the dala need not be disclosed to him for <br /> siz mondu thereafter unless a dispuu or acdon pursuanc to this secdon is pending or addiaonal data on the individual 6as been collected or created. <br /> The respoasible authoriry shall pmvide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesting person to pay the actual cosu of cnaking,cerdfying,and compiling the copies. � <br /> The responsible authoriry shall compiy immediately,if possible,with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possibte. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addiaoaal five days within which w comply with the request,exc(uding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or compl'ete. An individual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise this right,an individual shall nodfy in wricing the responsible authoriry describing rhe nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct rhe data found to be inaccurau or incomplete and attempt to nodfy past recipienu of <br /> inaccurdte or incomplete data,inciuding recipiencs named by du individual;or(b)notify the individual that he bclieves the data to be correct. Data <br /> in dispute shall be disclosed only if rhe individual's statement of disagreement is included with the disclosed data. <br /> The decermination of the responsible auchoriry may be appealed pursuant to the provisions of the adminisaadve proceduro act relaang to <br /> contesud 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 Ciry of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You aze 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 ihis application or permit. <br /> )o;�� P�A�S ����y <br /> First Middle Last <br /> . 3-z�s l��'P�E rC Rr�Gt CT <br /> Address . <br /> � o��j rn N S�3q 1 9 S z471 ���-7 <br /> City State Zip Phone <br /> I understand my rights as stated above. <br /> " 1� X� <br /> Sig re <br />