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Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information required to be givea individual. An individual asked to supply private or confidendal data concerning himself shall <br /> be informed of: (a)the purpose and intended use of the requested data within the collecang srate agency,poliacal subdivision,or statewide system; (b) <br /> whether he may refuse or is legally roquired to supply the requested data;(c)any Irnown consequence arising from his snpplying or refusing to supply <br /> privau or confidenaal data;and(d)the idendry of other persons or entities suthorized by state or federal law to receive the data. 'Ihis requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision 5,to a law enforcement o�cer. <br /> 'Ihe commissio�r of tevemie mav olace the notice teauitsd under this�bdivision in the individual income tax or aronectv tax refund insuvcrions <br /> instead of on chose forms. <br /> SLbd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored <br /> priva[e or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning <br /> of that data. After an individual 6as been shown the private data and infocmed of its meaning, the data need not be disclosed to him for six months <br /> theceafter unless a dispute or acaon pursuant to this section is pending or addidonal data on the individual has been collected or created. The responsible <br /> authoriry shall provide copies of the private or public data upon request by the i�ividual subject of t6e data. The responsible authoriry may require[he <br /> requesting penon to pay the actual costs of making,cerdfying,and compiling the copies. <br /> 'Ibe�esponsible authority shall comply iromediauly,if possible,with aay request made pursuant w this subdivision,or within five days of rhe <br /> date of the�equest,excluding Sawtdays,Slmdays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within <br /> that dme,he shall so inform the individual, and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays <br /> and legal holidays. <br /> Subd.4. Procedure whw data is n�accurate or rnmplete. An individual may contest the accuracy or compieteness of public or private data <br /> conceming himself. To exercise this right,an individual shall nodfy in writing the rospoasble authority describing the nature of the disagreement. The <br /> responsible authoriry shall wiThin 30 days either. (a)comect the data fou�to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate <br /> or incomptete data,u�cluding recipients named by the individual;or(b)noafy the individual that he believes the data to be correct. Data in dispute shall <br /> be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> 'Ibe deoemunadon of the responsible authoriry may be appealed pucsuant oo d�provisions of the administrative proceduro act relating to contested <br /> 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 fumish certain private or <br /> confidential infomiation. <br /> You are notified that: � <br /> 1. The information you fiunish 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 pemut or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary to process <br /> the pemut or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become 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 application or permit. <br /> ��� S ��e� <br /> First Middle I.ast <br /> p � • ��C �{7_� 33 <br /> Address <br /> e�/N/•��;Ls�i /lifir✓_ J,�y�f 7 Lol`7_ S'�5�3 Z 7 2� <br /> Ciry State Zip Phone <br /> I understand my rights stat ove. <br /> �� / _ <br /> Signature <br /> 10 <br />