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Sec./3.OJ RlGHTS OFSUBJECTS OFDATA � <br /> Subdivision/. Type ojdata 77re rights ojindividual on ivhom rhe data is s�ored or!o be stored sha[l be as set jorth in this section. � <br /> Subd.2. Ixjormation required to be given lndividuaL An individual asked�o supply privale or confidential data concerning himselJ <br /> sha/1 be injormed of (aJ thepurpose and intended use of the�eques�ed data wi�hin rhe collecting stale agenry,political subdivision,or state�vide <br /> system;(bJ whe�her he may iefuse or is lega!!y required to supply the reques�ed do�a;(c)any known consequence arising from his supplying or <br /> reftuing�o supplyprivate or confidenfial dafa;and(dJ!he identrty ojo�her persons or entilies aulhorized by state orjederal law to receive the data. <br /> This requisemenl shal!not app/y when an indivrdua/rs asked!o supply rnvesligative data,pursuant to seclron /3.81, subdivision 5, !o a!mv <br /> enjo�cement o�cer. <br /> The commrssioner ot revenue mav p/ace!he notice requrred under lhis subdivrsron in the indivrdua/income fax or propertv taz rejund <br /> insrructions instead ofon�hose forms. <br /> Su6d.3. Access to data by indlvlduoL Upon request to a responsibJe au�hority,an individuaf sha!/be informedivhether he rs the subjec� <br /> ojsfored dola on individuals,and ivhether it is classifred as public,private or confiden�ia/. Upon his jur�her requesl,an individua!who is the <br /> subjecf oJs�ored privnfe or pubfic data on individuals sha!!be shoivn the da�a tivi�hou�any cha�ge!o him and,if he desires,sha!!be injormed oJ <br /> lhe contenl and meaning ojtha!dala.'Ajter an indivrdua/has been shoivn fhe private data and injormed ojits meaning,1he data need not be <br /> discJosed to him jor six monlhs lhereajter unless a dispute or ac�ion pursuan!to lhis seclion rs pending or additrona!data on the rndividua!has <br /> been co!lected or created. The iesponsible authority sha/!provrde copies ojfhe priva�e or public dala upon request by Ihe rndrvidua[subjecl oj <br /> �he data. The resporaible autho�iry may require the�equesring person�o pay the actua!costs oJmaking,ceriifyrng,and compiling the copies. <br /> The�esponsible authority sha!/comp/y immedialely,iJpossib/e,tivrth any request madepursuant to lhis subdivision,or wi�hin ftve days <br /> ojthe dale ojlhe request,excluding Safurdays,Sundays and lega!holidays,ijrmmediale comp/iance is no�possible. IJhe cannol comply tivilh fhe <br /> request wilhi»that 1ime,he shall so injorm fhe individua/,a»d may have an addi�iopal frve days ivithin whrch�o comply with�he reques�,excluding <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when dalo is nof occurate o►complefe. An individual may conres!the accuracy or completeness ofpublic or prrvare <br /> data concerning himselJ To exercise�hrs rrgAf, an individual shall no��in tivriling lhe responsible aulhority describing Ihe na�ure ojthe <br /> disagreemen�. The responsib/e au(ho�itysha!!within 30 days either: (a)correcf the da�ajound�o be inaccurale or incomplete ond a�tempt fo no�� <br /> p6st recipien�s ojinaccura�e or incompfele da►a,lncluding recipients named by the individual;or(b)no���h¢indrvidua/lhat he believes[he dala <br /> �o be correcf. Data in dispute shall be disclosed only iJthe individua%s statement oJdisagreement is included with the disclosed data. <br /> 77re determinatiox ojthe responsible authority may be appeo%d pursuanl�o�he provisions ojthe adminrstrative procedure act relating <br /> 10 con�esred cases. <br /> DATA PRIVACYADV/SORY <br /> !n accordance with M.S./3.04,Subd.2,'Righls ofsubjec�s oJdala';ive tivould like to injorm you tha[your request jor a permil orlicense <br /> from the City ojOrono or any oJi1s depnrlmen�s may require you to jurnrsh certarn priva�e or confrdential injormation. <br /> You are no�ified fhat: <br /> 1. 77re injorma�ion you jurnish wi(/be used ro determine your qualifica�ion jor the permil or license reques�ed. <br /> 2. You may refuse 10 supply dafa,bul refuso!may require�hat�he Ciry deny�he permit or license. <br /> 3. The injorma�ion may be shared tivith ofher locnl,state or jederal agencres to the exlent necessary[o process the permit or <br /> license. <br /> 4. IJyour requested permi�or lrcense reqaires Counci!ac[ion!o approve,some informa�ion may become publrc. <br /> 5. You have certain righ�s under M.S. 13.04(see jo!lowing page)�o revietiv prrvate data on yourself. <br /> 6. Your fu!!name is required�o process this application or permit. <br /> PLEASE PRINT <br /> Fi�st ' Middfe Last <br /> Address <br /> Crty Sfate Zip Phone <br /> !unders�and my rights as srated above. <br /> Signature <br /> /0 <br />