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� �, � � <br /> Sec.13.04 I21GfiTS OF SUBJECTS OF DA7'A <br /> Subd. 1. "Iype of data. The rights oC individual on whom the data is stored or to be stored shall be as set forih in this section. <br /> Subd.2. Information required to be given individuaL An individual asked to supply private orconfidential data conceming himselfshali be <br /> iuformed of: (a)the purpose and intended use of the requested data witliin the collecting state agency,political subdivision,or statewide system;(b) <br /> �ehether he may refuse or is legally required to supply the reyuested data;(c)any kno«��consequence arising from his supplying or refusing to supply <br /> private or conf idential data;and(d)the identity o(other persons or entities authorized by slate or federal law to receive the data. This reyuirement shall <br /> not apply�vhen an individual is asked to supply investigative dala,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The cmmnissioner oCrevenue ma lace the notice re uired under this subdivision in t6e individual income tax or ro ert�tax refund <br /> instructions instead of on those fonns. <br /> 5ubd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whetlier it is classified as public,private or confidential. Upon his further request,an individual who is the subject of <br /> stored priva(e or public data on individuals shall be sho��m the data without any charge to him and,iFhe desires,shall be informed of the c;ontent and <br /> ineaning of that data. Afler an individual has been shown the private data and informed of its meaning,the da(a need not be disclosed to him for six <br /> months therea(ler wiless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public dala upon reyuest by the individuai suUject of the data. The responsible audiority <br /> may require the requesting person to pay the actual costs of making,certiFying,and compiling the copies. <br /> The responsible authority shall comply iinmediately,ifpossible;with auy reyuest made pursuaut to this subdivision,or��ithin five days of <br /> the date of the reyuest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply�vith the request <br /> �a ithin that time,he shall so infortn the individual,and rnay have an addilional five days witl�in�ahich to compiy���ith the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure�vhen data is not accurate or complete.An individual rnay contest the accuracy or completeness ofpublic or privale dala <br /> concerning himself. To exercise lhis right,an individual shall notify in writing the responsible authority describing lhe nature ofihe disagreement. The <br /> responsible authority shall«ithin 30 days either. (a)correct the data found to be inaccurate or incomplete and altempt to notify past recipients of <br /> inaccurate or incomplele data,including recipients named by the individual;or(b)notify the individu�l that he Uelieves Uie data to be correct. Data in <br /> dispute shall be disclosed only iCthe individual's statement ofdisagreement is included with die disclosed data. <br /> The detennination of[he responsible aulhority may be appealed pursuant to the provisions of the administrative procedure act relating to <br /> contested cases. <br /> DA1'A PRIVACY ADVISORY <br /> In accordance�vith M.S. 13.04,Subd.2,"Rights oCsubiects of data",we�vould like to infonn you that your request <br /> for a permil or license from the City of Orono vr any of its departments tnay reyuire you to furnish certain private or <br /> conildential information, <br /> You are notified that: <br /> 1• The informatioii you furnish will be used to determine ti�our qualification for the permit oE� license <br /> requested. <br /> Z• You may refuse to supply data,but rei'usal may require that the City deny the permit or license. <br /> 3. The information may be shared with vlher local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> �• lf}our requested permit or license reyuires Council action to approve, some infonnation may become <br /> public. <br /> 5• You have certain rights under M.S. 13.04(available upon request)to revie�v private data on yourselF. <br /> �• Your full name is required to process this application or permit. <br /> —� T <br /> ct iYl�'� ��f�u /� / <br /> /� cC{1 <br /> First Dliddle <br /> / Last <br /> //''� .(ct�C r� �� �`. c f <br /> Address <br /> _ i t /,: ,; .�; fi �.%:�./ _ _ <br /> �� � � `T/ �.�� y7�, �.�cc� <br /> City Siate <br /> Zip Phone <br /> I understand„tu� ' l�ts�s stated above. <br /> � �� <br /> Sig ture -' �. <br /> -///� r <br /> �, <br /> 32 <br />