`� �
<br /> . �
<br /> Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
<br /> Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as set fonh in this secdon.
<br /> Subd.2. Information required to be given individuai. r1n individual asked to supply private or confidenrial data concerning himself shall
<br /> be informed of: (a)the purpose and inte�ded use of the requested data within the collecting'sta[e agency, polidcal subdivision,or statewide system;
<br /> (b)whether he may refuse or is legalty required to suppty the reques[zd data;(c)any i�own consequence arising from his supplying or refusing to suppty
<br /> priva�e or confidendal data;and(d)the idendry of other persons or enriries authorized by state or federal law to receive the data. This requirement shall
<br /> not apply when an individual is asked co suppfy invesagative dan, pursuant to secrion 13.82, subdivision 5, to a law enforcement ofFcer.
<br /> The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or prooertv tax refund
<br /> inscrucrions instead of on those forms.
<br /> Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subjecc
<br /> of stored data on individuais, and whether it is classified as public, private or confidential. Upon his further request,an individual who is the subject
<br /> of stored priva[e or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the contenc
<br /> and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for
<br /> six months thereafter unless a dispute or action pursuant to this section is pending or addiaonal data on the individual has been collected or crea[ed.
<br /> The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible auchoriry
<br /> may require the requesting person to pay the actual cosu of making, cemfying, and compiling the copies.
<br /> The responsible au[horiry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of
<br /> the date of the request,excluding Saturdays,Sundays and(egal holidays,if immediate compliance is not possible. If he cannot comply with the reques[
<br /> within that time,he shall so infornt the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays,
<br /> Sundays and legal holidays.
<br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
<br /> data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.
<br /> The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipiencs of
<br /> inaccurate or incompiete data, including recipients named by the individual; or(b) notify the individual that he believes the data to be correct. Data
<br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
<br /> The determination of the responsible authoriry may be appealed pursuant ro the provisions of the administrarive procedure act relating to
<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 are notified that:
<br /> 1. The information you fumish will be used to deternune your qualification for the permit or license requested.
<br /> 2. You may refuse to supply data, but refusal may require that [he City deny the pernut or license.
<br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary [o process
<br /> the pemut or license.
<br /> 4. If your requested permi[ or license requires Council action to approve, some information may become
<br /> public.
<br /> 5, You have cercain 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 /> 1
<br /> -�-f�� '�_�� ���`;�-_� r � 1, �' ��' ,�
<br /> First Middle Lasc
<br /> > j� � vr,�� S�+-� /'''�< —
<br /> Address ,, � _ , �
<br /> ._ c_
<br /> ���� � ����� /��-i�,� = - ,"j ,/ !���— C,���� �- /
<br /> C�h, State Zip Phone
<br /> I understand my ri�hts as st�ted above.
<br /> , ,
<br /> ,
<br /> -
<br /> � �-' ; � �
<br /> , �
<br /> �,�
<br /> '�l � ;rz_�-, � � � ��-- -_
<br /> Signature
<br />
|