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"♦ <br /> , <br /> Sec.13.04 RIGHTS OF S[JBJECTS OF DATA <br /> Subd. i. Type o[data. 'Ihe rightt of individual on whom the dara is stoced or ro be stoted shall be as set forth in this section. <br /> Subd.2. Intormatton reqirired to be givm individi�aL An iadividual acked ro supply private or confidendal data concerning hi�telf shall <br /> be informed of: (a)the purpose and inrended use of the:equesud data wiehin the collecdng state agency,poGdcal subdivition,or statewide rysum; <br /> (b)whether he may refuse ot ic legaily requicrd w supply the requesud data;(c)aay imown wnsequeace arising fivm his supplying or refiuiag to supply <br /> privace or confidendal dara;and(d)the idendry of other persoat or enddcs authorized by srate or federa!law to ceceive the dara. 'Ihis requirement3ha11 <br /> not apply when an individual is asked W supply invesdgadve dara,punvant to secdon 13.82,subdivision S,to a law enfoceemeat officer. <br /> The commissioner of revenue mav olace the norice iewircd under ehis subdivision in the individual income taz or orovem taz refund <br /> inscrucaons iascead of on[hose forms. <br /> Subd.3. Accas to data by individual. Upon request to a responsible authoriry,an individual shall be inforwed whether he is the subject ' <br /> of stored data on individuals,and whethec it is class�ed a�s public,private or confidenaal. Upon his furthec iequest,an individual who is the subject <br /> of stored private or pubtic data oa individuals shall be shown the dara wirhouc any c6arge to him and:if he desires,shall be informed of the content <br /> and meaning of that data. Aher an individual has been showa the privace dara aad infocmed of its meaaing,the data aeed not be disclosed oo him for <br /> six months thereafur unleu a dispute or accon pursuanc to[his ucaon is pending or addiaonal data on the individual has been collecud or creaad. <br /> The responsible authority shall pmvide copies of the privare or public dara upon request by the individual subject of rhe dara. The responsible authoriry <br /> may requue the nques6ng person to pay the actual cosu of making,certifying,and compiling the copies. <br /> T6e responsible authoriry shall comply iaunediately,if possible,with any reqvest made pursuant m this subdivision,or wichia five days of <br /> the date of the cequest,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot comply with the request <br /> within that dme,he shali so inform the individual,and tnay have an addiaonal five days within which to comply with the request,excluding Sadudays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or eomplete. An individual may contest the accuracy or completeness of public or privam <br /> data conceming himself. To exereise chis right,an individual shall nodfy ia wriring the responsible authoriry describing the nature of the disagreement <br /> The nsponsible authority shall withia 30 days either. (a)correct the data found ro be inaccucate or incomplete and aaempt W noafy past recipients of <br /> inaccurate or incomplete data, including recipients narned by the individuai;or(b)notify the individual that he believes the data ro be correct Data <br /> in dispute shall be disclosed only if the individual's statemenc of disagreement is included wich the disclosed data. <br /> The determinaaon of the responsble authoriry may be appealed pursuant to the provisions of the admiaisaauve procedure act relaang w <br /> contested 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 City 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 shazed with other local, state or federal agencies to the eztent 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 this applica[ion or permic. <br /> �� � � � ' <br /> First Middle p� Last <br /> /�C /' l30 �- .S� .�"� � <br /> Address � r,� `�S� ��� G 9�9 r 9�� <br /> �i��-���--- �%�..�--L. � <br /> Ciry Stare Zip Phone <br /> I understand my rights as stated above. <br /> ��' . �T- ''�2�/�'�-`�-t--� <br /> ./r7 ' <br /> Signamre <br />