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_ iy ` <br /> Sec.13.01 RIGHTS OF SUBJECTS OF DAT?, <br /> Subd. 1. Type of data. The righcs of individual on whom[h�data is stored or to be scnred sha11 be as set forth in this secdon. <br /> Subd.2. InformaGoa reqirired to be given individual. ?.n individual asked to supply privace or confidzaaal data concerning himseif shall <br /> bz informed of: (a)the purpose and incended use of the reques�dara wichin[he collecdng 3tac�a,eacy, poliacal subdivision,or sratewide system; <br /> (b)whe�fier he may refuse or is legally required co supply the r.quested data;(c)any lrnown coasequeace arising from his supplying or refusing to supply <br /> priva[e or con�idendal dara;and(d)the idendry of o[her pecsoas or enrides aurhorized by sc�te or federal law to receive the data. This requ'uemeot shall <br /> no[appiy whan an individual is asked to supply invesa¢adve dara, pursuanc to secaon 13.82, subdivision 5, to a(aw enforcemen[ofricer. - <br /> lltz commissioner of revenue mav place che norir r�ouired under this subdivision in the individuai income tax or orooem taz refund <br /> inscrucrions insczad of on those forms. <br /> Subd. 3. Access to data by iadiridual. tipon rcquest to a responsiblz auchoriry,an individual shall be informed whe�her hz is the subject <br /> of scored dara on individuals,and whecher it is ciassified as pubiic, privace or conFdenaal. Upon his furcher requesc, an individual who is the subjea <br /> of s[ored priva[e or public dara on individuals shall be shown che dan wi�hout any charge to him and,-if he desires, shall be informed of che content <br /> and meaning of[hat data. Aher an individual has been shown[he privace data and informed of ics meaning,tbe data need not be disclosed to him for <br /> siz monchs thereatter uniess a dispu[e or acaon pursuane to this secaon is pending or addidoaal data on the individual has been collzeced or crearrd. <br /> The responsible au�horiry shall provide copies of the privace or public data upon requesc by the individual subjecc of the data. 'Ihz responsible authoriry <br /> may require [he requesring person to pay the actual costs of making,cerafying,and compiling the copies. <br /> The responsible auchority shall compiy immediately, if possible,with any request made pursuant to this subdivision, or wichin five days of <br /> the dace of tha requesc,exciuding Sacurdays,Sundays and legal holidays,if immzdiate compliance is not possible. If he canno�comply with the reques� <br /> wi[hin chat dme,he shail so inform the individual,and may have an addiaonal Five days within which to comp(y with the requesc,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple�enzss of public or pri�•ate <br /> dara concerning himself. To execcise�his rieht,an individual shall noa"ry in wricing che responsibla auchoriry describing the nacure of the disagreement. <br /> The responsibie authoriry shall wichin 30 days eicher: (a)correcc the data found to be inaccurate or incomplete and attempt to nodfy past recipien�s of <br /> inaccurdta or incomplece data, including recipiena named by the individual; or(b)nocify [he individual that he believes thz data to be coaect. Data <br /> in dispute shali be disclosed only if the individual's sc3temenc of disagreement is included with[he disclosed data. <br /> Thz decerminarion of the responsible authoriry may be appzaled pursuant to the provisions of the admicusaarive procedure act re(adng to <br /> concesced cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri;hts of subjects of data", we would like to inform you that your request <br /> for a permit or license from the Ciry of Orono or any of its deparcments 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 wich other local, state or federal a�encies to the extent 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 onyouurself. <br /> 6. Your full name is required to process this application or permit. <br /> � <br /> �����C '� ����\ ��� ��=� �f� G-� � � � <br /> L <br /> Firsc C- �1�d�z c-- Last <br /> ,z,�a � � . �O - ' -� / . <br /> Address i C �� /_ <br /> ��c,�_, �z, .-� c� � �� .��, %� �jr�� ���-�� c��, �� - �-��� � <br /> City Sate Zip Phone <br /> ,. <br /> ? <br /> I understand m��;�i�s as s ed above. ,/ <br /> � ,�. <br /> - �? =� <br /> Signacure <br />