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r ' � <br /> Sec.13.04 RIGHTS OF SL`BJECTS OF DATA � <br /> � <br /> Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information required to be givea indiridual. .�n individual asked to supply private or confidential data conceming himself <br /> shall be informed of: (a)the�rpose and intended use of the requestd data wi[hin rhe collecang state agency,polidcal subdivision,or statewide <br /> ryscem;(b)whecher he may refuse or is IegaUy required to suppty the requested data;(c)any lmown consequence arising from his supplying or <br /> refusing to supply private or coafidential dara;and(d)the identiry of o�er persons or entiaes authorized by sra[e or federal law co receive the data. <br /> This requirement shall not apply when an individual is asked to s�ply invesagadve data, pursuant to secdon 13.82, subdivision S, to a law <br /> enforcement o�cer. <br /> The cemmissioner of revenue mav olace the noece rcwired under this a�bdivision in the individual income taz or oro rtv tax refund <br /> instrucrions mscead of on those fortn . <br /> Subd.3. Access to data by individual. Upon request w a responsible authoriry,an individual shall be informed whether he is the <br /> subject of stored data on individuals,and whether it is classified as public,private or confidenaal. Upon his further request,an individual who <br /> is the subject of stored privare or public data on individuals shall be shown[he dara without any charge to him and,if he desires,shall be informed <br /> of the content and meanin�of rhat dara. After an individual has been shown the private data and informed of its meaning,the data need not be <br /> disciosed to him for six months the�eaf[er unless a dispute or acdon pursuant to this secaon is pe�ing or addirional data on[6e individual has been <br /> colizcted or created. The resporuible authoriry shall provide copies of�e private or public data upon request by the individual subject of the data. <br /> The responsible aurhoriry may require the requesang person to pay the actual costs of making,certifying,and compiling the copies. <br /> Tht�espotuible authority shall comply immediately,if poss�le,with any request made pursuant to this subdivision,or within five days <br /> of[he dace of the r_quest,exciuding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> che request wichin that time, he shall so inform the individual,and may have an addiaonal five days within which to comply with the requesc, <br /> excluding Saturdays,Sundays and legal holidays. <br /> Subd.�i. Procedure when data is aot accurate or complete. An individual may contest the accuracy or completeness of public or <br /> private dard concerning himself. To exercise this right,an individual shall noafy in wridng the responsible authoriry describing the t�ature of the <br /> disagreement. 'lhe responsible authoriry shall withir►30 days either. (a)correct the data found to be inaccurate or incomplete and atumpt ro noafy <br /> past recipiencc of iraccurate or incomple�e dara,inctuding recipients na�cd by the individual;or(b)noafy the individual that he believes the data <br /> to be correct. Daa in dispute shall be disclosed only if the individual's statement of disagreement is included with the disctosed data. <br /> The dewaninaaon of rhe iesponsible authoriry may be ap�a!ed pursuant to the provisions of the administrative procedure act relaang <br /> [o contested cases. � <br /> DATA PRIVACY ADVI ORY <br /> In accordance with N1.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the �ity of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You aze notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license � <br /> 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 extent necessary to <br /> process 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.Q4(available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> lil/.`�- C.� � �o L L/�,/�,D <br /> F�rst Middle ' Last <br /> �// � Go�.t �,��J.� //�J <br /> Address <br /> �i���D �� Ss3�y 95�. y�z r�s3 <br /> C�ry State Zip Phone <br /> I understand my rights as state bove. <br /> Signamre � <br /> . <br /> 6 <br />