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Sec.13.04 RIGHTS OF SUBJECTS OF DaT� <br /> Subd. l. Type of data. 'Ihe righcs o[individual on whom the dara is stored or m be stored shil be as set forth in this secrioa <br /> Subd.'_. Iaformation reqtrired to be�vea iadividual. ?.n iadividual�sked co supply privarc or confiden^�l dara conceraing himself shall <br /> be informed of: (a)[he purpose and int.-.nded use of�he cequested dara wichin che colleccing'stata agency,Folidcal�:3division,or sracewide rystem; <br /> �b)whe:her he may refuse or is legally Rquiced ro supply�he requested dara:(c)any lmown coas:queace arisi3 from his a:pptyin,or refusing m supply <br /> privare or conndendal dara;and(d)�he idenrity of o�er persoas or endaes auchorized by sta�.or fedzral law ro r.�eive�e da�a. 'Ihis requiremea�shaII <br /> not appfy when an individual is asked to suppty ia��esri¢adve dam,pursuant to secaon 13.82,subdivision�, �a law eaiorceca�nc ofFicer. <br /> 'Ihe commissioner of re�enu nav pir �he nodc r-auired under �his subdivision in the indiv:Cual_ir.cor..e ax or prooem mz refur.d <br /> ins:rucdons instzad of on chose forms. <br /> Subd.3. ?,ecess to data b�individual. lipon request to a responsible auchority,an individual s:all be infor.ied whecher he is the subject <br /> of scor_d daca on individuals,and whe:her ic is ctass�ed as pubiic, privace or confidendal. L;pon his furth::r.quest, an individual who is the subjecc <br /> of stord privace or public data on indi�•iduals shall be shown�he dara wichout any charge tD him and,'if he dasires, s�all be iniormed of the concer.: <br /> and meaning oi chat daca_ After an individua!hu be=n shown[he privace dan and informed oi iu meanin3,[�e dara�ed no�be disclosed oo him for <br /> six mondu cher-aiur unless a dispute or acrion pucsuanc to [his secdon is pending or addidoaal dara on c�e ir.dividi:al has bzea collected or creared. <br /> Tne responsible au�horiry shali provida copies of�hz privaee or public data upon requese by the individual n:b;�c of c�c ciam. T"ne responsible au[horicy <br /> may require the requesring person to pay che acn3al cose�of malcing.certifying,and compiling[he copies. <br /> The�esponsibiz au[horiry shall comply immediately, if possible, wirh any request madz pursuu:t�thi5 subdivision,or within five days oi <br /> the date of che request,ezciuding Saturdays.Sundays and legal holidays,if immediace complia�ce is no�poss�Ie. If he c3nnot comply with[he request <br /> wichin chac dme,he shall so inform[he individual,and may have an addidonal Five days wichin which to comciy wi��request,excluding Samrdays. <br /> Sundays and legsl holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may concest che ace��cy or conpleceness of public or pri�•ace ' <br /> data conceming himseff. To exercise chis right,an individual shall noafy in wridn;�he respoastble auchorirv d:scribiag ct:e nani:e of the disagreemea� . <br /> The responsible auchoriry shall wichin 30 days ei�`.er: (a)correcc the dara found ro be inac:urace or incomp'.��and a^..�pt to nodfy past recipients ei <br /> inaccuram or incomplece dac�, inciuding recipiencs named by the individual; or(b)aorify [l:e individual t;a:he 6elievu the dara to be correct. Dan <br /> in dispuce shall be disc:osed only if[he individuai's sratemenc of disagreemenc is ir.cluded wich[he disclos:�daca. <br /> The decerrtunaaon of tha responsible au�horiry may be appealed pursuanc to the provisions of c:=admins�dve procedure act relacing to <br /> contes�ed cases. <br /> DAT�, PRIVACY ADVISORY <br /> In accordance wich M.S. 13.04, Subd.2, "RiQhes of subjects of data", we would li{e to in�orm you that your reques: <br /> for a permit or license from the Ciry of Orono or any of its departments may require you to fumish certain private or <br /> confidencial information. <br /> You are notified that: <br /> 1, The information you furnish will be used to determine your qualifica[ion tor che oermit or license requested. <br /> ?, You may refuse to supply daca, but refusal may require thac the Ciry deny the permit or license. <br /> 3. The information may be shared with ocher local, scace or federal a�encies co the eztenc necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may becocie <br /> public. <br /> �. You have cenain righcs under �1.5. 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 /> First �tiddle Last <br /> Address <br /> Ciry Snce Zip Phone <br /> I understan�my ri�hts as stated �v�' . <br /> ,� '�" � / <br /> / �'," �� <br /> Signature - <br />