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. � <br /> Sec./3.04 RIGHTSOFSUBlECTSOFDATA . <br /> Subdivision!. Type ojda�2 The rights oJindrvidua!on ivhom!he dala is stored or�o be stored sha!l be as se�jorth in this section. <br /> Subd.1. lnjor�na�lon requlred to be given lndivlduaL An rndividua/asked to supplyprivate or confrdenria/data concernrng himselj <br /> shal!be injormed oj.• (a)�he purpose and intended use oj�he reques�ed dala wrlhin lhe collecling sla�e agency,polilicaJ subdivision,or sfatewide <br /> system;(b)whether he may rejuse or is/ega/!y�equised to supply the reques�ed dafa;(cJ any known consequence arising from his supp/ying or <br /> �efusing to supply private or confrdential data;and(d)the identrty oJo�her persons or enti�ies au�horited by stale orjederal!mv to receive the data. <br /> This requirement sholl not app[y when an individua!is asked lo supply investigalrve data,pursuanl�o sec[ion /3.82,subdivision S, 10 a!mv <br /> enjorcement o�cer. <br /> The commissioner ot revenue mav place�he no�ice reaurred u�rder�hrs subdivision rn 1he rndivrdua!rncome!ax or nroperry tax refund <br /> instruclions�ns�ead oton those torms. <br /> Subd.3. Accesslo data by indivlduaL Upon request�o a responsible authoriry,an indrvrdual shall be injormed whe�her he is the subject <br /> ojslored data on individua[s,and whether i�is classified as public,private or confrdenlral. Upon hrs jur�her requesf,an individua!who is!he <br /> subject ojs�ored psivale or public da�a on individuals shaU be shoivn�he da�a ivirhout any charge lo him and,if he desrres,shal!be informed oj <br /> the content arrd meaning ojthat data.'AJler an r�rdrvidual has been shoivn fhe priva�e data and injormed of rts meaning, !he data need nof be <br /> disc%sed!o him jor six months lhereaJter unless a dispute or ac�ion pursuant to this seclion is pending or addi�iona!data on the individua!has <br /> been coJlected or creared. The responsible aurhoriry sha!/provide copies ojthe private or public data upon request by�he rndrvidua!subject oJ <br /> �he data. The responsible aurhority may requi�e the reques�ing person to pay rhe nc�ua!cos�s of making,cer�ifyrng,and compiling rhe copies. <br /> The responsible aurhority ahal/compJy immediately,if possibJe,ivi�h any reques�made pursuan�to�his subdivisron,or tivi�hin frve days <br /> ojthe date oJthe request,excluding Salurdays,Sundays and legal holidays,rf immedia�e compliance is not possib/e. Ijhe canno!comply ivrlh the <br /> request withix lhat time,he shal!so injorm the indrvidual,and may have an addiliopalfive days ivithrn whrch�o comp/y ivith the request,excluding <br /> Salurdays,Sundays and/egal holidays. <br /> Subd.4. Procedure when dala is nol accurale or comp/ele An individua!may conresr the accuracy or complereness oJpublic orprrvare <br /> dnta concerning himself To exercise Ihis righ�, an individual shall not�in writing the responsible nuthority describing 1he nature oJthe <br /> disagreement. The responsible au�hority sha!!wilhin 30 days ei�her: (a)correct�he datajound[o be inaccura�e or incomple�e and artempt�o no�� <br /> phs��ecipients ojinaccura�e or incomp/e�e da�a,inc/udingrecipien/s named by�he individual;or(bJ no��the individua!lha�he believes the da�a <br /> �o be correct. Data in dispu�e shal!be disclosed only rf�he individua!'s sla�emenl of disagreemenl is inc/uded with the disclosed data. <br /> The determination ojthe responsible au�horrty may be nppealed pursuant�o the provisions ajthe admixislrative procedure acl relating <br /> �o contested cases. <br /> DATA PR/VACYADV/SORY <br /> /n accordance wi�h M.S.13.04,Subd.2,"Righrs oJsubjects oJdara';we would/ike lo injorm you�hat your reques�for a permi�or/icense <br /> Jrom the City oJOroxo or any oJrts deparlments may require you to jurnish cerlain private or confiden[ial injormafion. <br /> You are notrfred tha1: <br /> l. The injorma�ion you furnish wi!!be used to derermine your qualrficntion jor the permit or license requested. <br /> 2. You may rejuse�o supply dota,but reJusa!may require�ha�the City deny the permi�or license. <br /> 3. The injormntion may be shared ivith other local,stote or jederaf agencies to the extenr necessary to process!he permi�or <br /> license. <br /> 4. /jyour requested permil or license requires Counci!aclion�o approve,some injo�ma�ion may become public. <br /> S. You have certain righ�s under M.S. 13.04(see jollo�vrng page)�o revietiv private data on yourself. <br /> 6. Your jull»ame is required fo process this npplica�ion or permif. <br /> PLEASE PRINT <br /> Frrst ' ' Middle Las� <br /> Address <br /> Ciry State Zip Phone <br /> /undersland my rights as sta�ed above. <br /> Srgnature <br /> !0 <br />