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Sec.13.04 RIGHTSOFSUBJECTSOFDATA <br /> ' � ~ � Sabdivision 1. Type oJdata The rights ojindividual on whom lhe data is stored or to be stored shal!be as set jo�th tn lhis sectJon. <br /> Subd 2. Injormation requlred to be gfven JxdfviduaL An rndivrdua!asked to supply privaJe or confidentio!data concerning himselj <br /> shal!be informed of (a)the purpose and intended use of th¢requested data w!lhin the col/ec�ing state agency,poli�rca!subdivision,or s�atewide <br /> system;(bJ whether he may sefuse o�fs legally required to supply the requested data;(c)nny lrnown coraequence arising from his supplying or <br /> refusing to supply prtvate or confide»lra!data;and(d)the identity of other persons or enrities authorrzed by s�a�e orfederal law to receive the data. <br /> This�equir¢ment shal!not apply when a»indrvtdual is asked�o supply imestigative data,pursuant to section 13.82, subdivision S,�to a law <br /> enjorcement o„�'tcer. <br /> The commlrsroner olrevexue mav nl4ce the notrce reauired under lhrs subdivfsion in the indivrdua!ixcome�ax or o�onertv�ax refund <br /> tiistructioru instead oton those fosms. <br /> Subd.3.Access to data by tndlvlduaL Upon request�o a responslble au�hority,an indivrdual shall be informed whether he rs the subject <br /> of sro�ed data on indivrduals,and whe�her it is classifred as public,privote or confidentia[. Upon his further request,an individual who rs the <br /> subject ojs�o�ed private or pub[ic data on ixdivrduals shal!be shown the data without a�ry chcvge�o him arrd,if he desi�es,sha!!be informed oj <br /> the content and meanixg of�hat data After on individual has been shown�he prrvate datn and lnjornred of ifs meaning,the da�a xeed xot be <br /> disclased to him for srx months�hereafter unless a dispule or action pursuan�to this sectron is pendixg or additronal dato on the indrvidua!has <br /> been collected or created The responsible aulhority shall provrde copies ojthe privote or publrc data upon request by�he individual subject oj <br /> �he data. The responsible authorlty may requrre rhe requesting person to pay the actual costs of making,cer��ing,axd compiling the copies. <br /> The responsible authority shall comply rmmedia[ely,ijpossible,wilh 4ny�equeat made pursuaxt to this subdivisiox,or wirhin five days <br /> oJrhe date of the request,ezcluding Sa�urdays,Sundays and legal holidays,!f immedrate comp/iance is not posaible. If Re cannot comply with the <br /> request withix�hat trme,he shall so inform lhe individua/,and may have ax additional frve days within which ro comply with fiie request,excluding <br /> Snturdays,Sundays and lega!holidays. <br /> Subd 4.Procedu�e when data is not accurate or complete An brdividual may contest the accwacy or completeness oJpublic or private <br /> data concerning himself. To exercise thrs right, an individua!shal!not�in wri�ixg tAe responsible autbo�ity describing�he nature of the <br /> disagreement. The responsible au�hority shal/wi�hin 30 days erther: (a)correct the datafound to be inaccura[e o�incomplete and attempt to not� <br /> past reciptents oJinaccurate or incomplete data,tncluding recipients named by the individual;or(b)not�the fndivfdua/that he believes rhe data <br /> to be conect. Dota tn dtspute sha/1 be dtsclosed on/y tf the irrdividual's statemenl ojdlsagreemen[is inc/uded with the drscJosed data. <br /> - The determinat�on ojthe responsib/e autho�ity may be appealed pursuant to 1he prwisioxs ojtl�e adminrsbofive procedure act relating <br /> 10 contes�ed cases. <br /> DATA PRIVACYADYISORY <br /> In accordance wilh M.S 13.04,Subd 2,Rights ofsubjects oJdata",we wou/d/rke to informyou thatyour�equestfor apermit or license <br /> from the City oJOrono or ary of its departmenls may reguire you to furnrsh cerinrn privete os confrdential information. <br /> You are notlfred that: <br /> l. The lnjornrallon you furnish will be used to dete�mixe your qualiftcaJion for the permit or liceirse requested. <br /> 2. You may refuse to supply da�a,bat refusal may requr�e that the Ci�y derry�he permit or licerae. <br /> 3. The informaffon may b¢shared with other local,state or jedera!agencres lo the extenJ necessary to process the permit or <br /> license. <br /> 4. If your requested permit o�lfcense requires Counci!action to opprove,some information may become public. <br /> S. You have ce�tain righ�s under M.S.13.04(aee following page)to review private data on yourself. <br /> 6. Your full name Is required to proce.ts this application or permit. <br /> PLEASE PRINT <br /> S'�cJ e.� �. �d� � <br /> First Mtddle Las1 <br /> ��S`�� <br /> Address (� �. �-(� <br /> L��� L� f�� M � . �3�s �.�� Y7 3 �-� �S <br /> Crty Sta�e Zip Phone <br /> !understaxd y rv ta �ed bove. <br /> Stgnature <br /> 10 <br />