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4 � <br /> Sec.13.04 RIGHTS OF SIJBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Stitbd.2. Information reqirired to be given individual. An individual asked to supply privaze or confidential data conceming hunself shall <br /> be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system; (b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idendry of other persons or endties authorized by state or federal law to receive the dara. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82,subdivuion 5, to a law enforcement officer. <br /> The commissioner of revernie mav alace the nouce cewued under this subdivision in the individual income taz or propertv tax refund instructions <br /> instead of on those fom�s. <br /> S�bd.3. Access to data by mdividual. Upon request to a respoc�sible authoriry,an individual shall be informed whether he is the subject of <br /> stom�data on individuals,and whether it is classified ac public,private or confidential. Upon his further reqaest, an�individual who is the subject of stored <br /> privaoe 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 has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months <br /> theceafter unless a dispute or action pursuant to this secdon 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 individual subject of the dara. The responsible authority may require the <br /> requesting person to pay the actual cosu of making,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately, if possible,with any request made pursuant to dus subdivision,or within five days of the <br /> daoe of the�equest,excluding Saainiays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request within <br /> that oime,he shall so inform the individual,and may have an additional five days within which to comply ccith the request,excluding Satucdays, Sundays <br /> and legal holidays. <br /> Subd.4. Procedure when data is not accurate or rnmplete. An individual may contest the accuracy or completeness of public or private daa <br /> conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The <br /> iespons�'ble authoriry shall within 30 days either: (a)correct the data found to be inaccurdte or incomplete affi attempt to notify past recipients of inaccurate <br /> or incomplete daffi,including recipients named by the individual;or(b)notify the individual that he belie�-es die 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 /> The detecmination of die cesponsible authority may be appealed pu�suant to the ptovisions of the adminisuative procedure act alating 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 City of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You aze notified that: <br /> 1. The information you fumish will be used to determine your qualification for the pemut 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 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 /> �e�»ef� � • �d ��rn�c nv, <br /> First Mid le , Last <br /> �� ��'� Lo�� ���dc� A vP <br /> Address� 1� ��'? � /� i /�/ ���� ��oG ��I �l(OU <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> � <br /> Signature <br /> 10 <br />