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Sec.13.04 RIGHTS OFSUBJECTS OFDATA , <br /> Subdivision 1. Type ojdata ?he rights of individua!on whom the data is stored or to be stored shall be as set forth in this sectroh. <br /> Subd.2. Injormatiort required m be given individuaL An irrdivrdval asked to supply private or confidential data concerning himself ; <br /> shal!be informed of (a)the purpose and uuended use of the requested data xithin the co[lecting state agency,politica!subdivision,or stalewide <br /> system;(b)whether he may refuse or is legally required to supply the requesred data;(c)axy known corrsequence arising from his supplying or <br /> refusing to supplyprivate or confrdential data;and(d)the identity of other persoru o�entities authorized by state or federa!law to receive the data. <br /> This requirement shall not apply when an urdrvidua!is asked to supply imiestigative data,pursuant to section 13.82, subdivision S, 10 a law <br /> enfo�cemenl o�cer. <br /> The commissioner of revenue mav place the notice renuired under this subdivision in the individual income tax or oropertv tax refund <br /> instructiorrs instead of on those torms. <br /> Subd.3.Access to data by indinzduaL Upon request to a resporuible au�hority,an individual shall be rnformed whether he is the subject <br /> of stored data on indrviduals,and whether it is classified as publrc,private or confidential. Upon his further request,an individual who is the <br /> subjecl of stored prrvate or public data on individuals shall be shown the daJa without arry charge to hrm and,rf he desires,shall be informed oJ <br /> the content and meaning of that data. After an individua!has been shown the private data and informed ojits meaning, the data need not be <br /> disclosed to hrm for six manths thereafter roiless a dispute or action pursumrt to this section is pending or additional data on the individual has <br /> been collected or created The responsible authority shall provrde copies of the prrvate or public data upon sequest by the individual subject of <br /> the data. The responsrble authority may require the requesting pe�son to pay the actual costs of making,cert�ing,and compiling lhe copies. <br /> The responsib/e authority shall comply immediately,if possible,w-ish any request made pursuant to this subdivision,or within five days <br /> oJthe date of the request,excludrng Satu�dvys,Sundays and legal holidays,rf immediate compliance is not possible. If he cannot comply with the <br /> request withrn that time,he shall so inform the indivrdual,and may have an additional five days wrthin which to comply with the request,excluding <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. P�ocedure when data is not accurate or complete An individual may contest the accuracy or completeness ofpublic or prrvate <br /> data concerning himseff. To exercise this right, an individual shall not��in writing the responsible authority describrng the nature of the <br /> disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to not� <br /> pas�recipients of inaccurate or incomplete data,includrng recipients named by the individuaf;or(6)not�the individual that he believes the data <br /> to be correct. Data in drspure shal!be disclosed only rf the indrvidual's statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authorrty may be appealed p�vsuant to the provisions of the administrative procedure act relating <br /> to contested cases. <br /> DATA PRIVACY�IDVISORY <br /> In accordance wrth M.S./3.04,Subd.2,"Rights ofsubjects of data".k�e would like to inform you that your requestfor a permit or license <br /> from the City of Orono or a�ry of its departments may reqaire you to furnish cestain private or confrdential rnformation. <br /> You are notrfred that: <br /> 1. The rnformation you farnish will be used to determiire��our qualification for the permit or license requested. <br /> 2. Y'ou may refuse to supply data,but refusal may require that!he City deny the permrt or license. <br /> 3. The information may be shared with other local,state or federa[agencies to the extent necessary to process the permit or <br /> lrcerue. <br /> 4. Ij}�our requested pernrit or license requrres Council action to approve,some information may become publrc. <br /> S. Y"ou have certain rights under M.S. 13.04(see follo»•vrg page)to review private data on yourself. <br /> 6. }'our fu!!narne is required to process this applrcatiorr or permit. <br /> P EAS�(tlV�1� C rrJ�I � <br /> ��e�5 �.• C�-�-�b�11 <br /> First Middle Last <br /> 1Sil C� l..�a�n� 1�sZ 1►3\vC� <br /> Address <br /> 1s.M� LG�-� �/Y�� �S�iSCO <br /> Ciry State Zip Phone <br /> qsa -u�3-�� <br /> I u rsta my r h a tated above. , <br /> � � . <br /> Sigrrature <br /> IO <br />