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� <br /> r <br /> Sec.13.04 RIGHTS OF S[1B.TECTS OF DATA <br /> Subd. 1. Type of data. 'Ihe righcs of individual on whom the dara is stored or to be stored shall be as set for[h in this secdon. <br /> Subd.2. Information req�rired to be given individual. An individuai asked to supply private or confidenrial data concerning himself shall <br /> be informed of: (a)the purpose and iatended use of the requesud data within the collecang State agency,polidca!subdivision,or statewide rysum; <br /> (b)whecher he may refuse oY is legaliy required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply <br /> • private or confidenrial data;and(d)the ideadry of other persoas or endaes aa[horized by state or federal law to receive[he data. This requirement shall <br /> not apply when an individual is asked to supply invesdeadve dara,pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. - <br /> The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or prooertv raz refund <br /> instrucaons ins[ead of on[hose forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whecher it is etassified as public, privace or confidencial. Upon his furcher request,an individual who is the subjecc <br /> of stored privau or public data on individuals shall be shown rhe data wichout any charge to him and,-if he des'ues, shall be informed of the content <br /> and meaning of that dara. 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 monchs rhereafter unless a dispute or acdon pursuanc to chis secrion is pznding or addiaonal data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of[he private or public data upon requesc by the individual subjecc of che data. The responsible authoriry <br /> may require the requesdng person to pay the actual coscs of making,certifying,and compiling[he copies. <br /> T1te responsible authoriry shall comply immedia[ely,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 legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc <br /> within[hat time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,exciuding 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 himsetf. To exercise[his right,an individual shall noafy in writing the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipien[s named by the individual; or(b)noafy the individual that he believes rhe 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 determinadon of the responsible authoriry may be appealed pursuanc to the provisions of[he administracive procedure act relaang 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 pemut or license from the Ciry of Orono or any of its departments may require you to fumish certain private or <br /> confidential information. <br /> You are notified that: � <br /> 1. The information you furnish 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 permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the eztent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> 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 /> � 2.�1� �l��ot� C...� ��0�-✓ <br /> F�` 3�3� M e��r ���O� �� Last <br /> �v a <br /> s�ress �v� ��t 1` � ^ ��� a�, �33` �3� <br /> Ciry State Ztp Phone <br /> I understand my rights as stated above. <br /> �� <br /> Signamre <br />