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�May, 16, 2007 2; OOPM � � No. 0792 � �P. 2. <br /> � <br /> � . ; . .. , � . � . . . � .� . <br /> Sec13.04 RtGkl�'S OF SUBJECI'3 OF DATA <br /> Subd.1, Zypc of dasa. The rights of individual on whom rhe dam is stored or co bc scorcd sbaU bc a9 set forth in this section <br /> Subd.Z.Informatioa req�ed tu be�jven ind'mdusi.An zadividual ar�ked to suPP�Y Piivare or confideraiel da[a conceming himgelf sball be <br /> i�ormed of. (a)thc purpose and in�ellded use of the tequested datn within the wllectmg stete ase�tcy�Pol�cal subdivision.or sis�ewide syssem;(b) <br /> whetherlk may rafuse or is le6nlly required ta supply the Pequested dala:(o)at1Y known consequeAce acising from his sup�plying�retusing to supply <br /> privatc or confidernial data;and(d)the id�ntity a�other persons or arcidcs aushorized by stste or federal law to receive the data Twis requirement shell <br /> not apply when�individusl is aglccd m supply investigative dxt3,pursuaz�t to sectia�13.82,aubdivision 5,m a law c�tf'PrcomcM officcr. <br /> Thc cemmisaioner of revenue mav plaea tha�tice required under thia aubdivisien in thc individvsl income tax or�rn5c refimd <br /> in4mutions instea[1 pfon those famw. <br /> Subd 3.Acceaa to databy iudividual.Upon tequest lo a�sponsible autk�wity,an individval shsll be irtfprmcd whcthcT hc is thc subjcct of <br /> stored da�oa iadividuals,�WIIEtI]CC it 19 CIa49�Cd$4 pUbI1C,private or confidential. Upon his further roquest,an iadividwsl wk�o is the subject of <br /> staed privs�e or public da�on individuals shaU be sho►w the de�without arry ct+srge to him snd,i£l�c desires.shall be informed ofthe cornern and <br /> meaning of that daa. ARtr an individusl has bccn shown tbe private data and informed af ils meaning,the clata nced not be disclosed to him for�,ix <br /> mondw thc��&er uNess a dispute ar action p�asuam to this seccioa is pcndi�o�additional dara on the individual ha4 been collectal or cceaeed.The <br /> responsbla kurthority ahall providc copics af the privare or public data upan request by the individud subject of rhe dara',I'hc respo�iblc authority <br /> maY re4uire the cecluis�:►g Pe�to pay the ac�m1 cosrs of►�naking.cercifyiing�a�compiting the copi�s. <br /> "ll�e�sa�asrblc au�haity shall comply immediately,if pos�ible,with any request madc p�asuetu to chis subdivision,orwnhin5ve days of <br /> She dacz of the requ�st,wxluding Sesudsys,Stmdays snd lega]holidays,iYitntuedi3te compliaiux is not possibla If he ctmnot canp�y wirh the requcst <br /> within thas tbqc,he s�all so infotm the individual,2a�1 may have on additional�ivc days with�whichw comply�vith the request�euludirtg 3aturdaYs, <br /> Sundays and kgol holidays. <br /> Subd.4.Proexduce when dara is aot acetu'ate or cotnplote.An individuel may contestthe�curacy ar compkceness ofpublic orprivax dat� <br /> mnceming hims�l•P To exercise this ri�t,�individual shsl]notify in writir�gtlx responsible authority deseriba�g the nad,re a�the disogamecrt.'Che <br /> responsiblc autlwdry s�all widfa�30 days eilk�er: (a)eorrect tiu d,ua fo�a�d to be it�acctt�or a�compJcte and atteropt io notity pa�i recipiertts of <br /> inaccurate or incomplete datq including racipie�s t�amcd by the individual;or(b)noriCy the i�ividual Ihat he balieves the�h�to be correct�m <br /> dispure shall bc disclosed only ff the individual's sf�,tcaua�t of disa�ecmarn�s i�cluded wa�h the disclosed data. <br /> The dctermination of rl�e respons�blc a�hoci�Y�Y�RPP�ed pursuant to the provisions of the odministrative procedure act relsting m <br /> cornesoed cases. <br /> DATA PRiVACY ADVISOL2�Y <br /> In accordauce with M.5.13.04,Subd.2,"Rights of subjects of data",we wvuld Iike to ivaform you that your request <br /> for a permit or license from the City o�O.rono or any of its depercmeats may require you to furnish certain private or <br /> confidetriia�i�t;formation. <br /> You are noti5ed tha#: <br /> 1. The infor,�oation you furnish will be used to determinc your quali�ication �'or the penauit or license <br /> requested. <br /> 2. You may refuse to suppay data,but refusal may requite that the City dtny the peamit or license. , <br /> 3. The information may be shared with other aocal, state or federal agencies to the extent necessary to <br /> process che permit or lice�ase. <br /> 4. �Fyowr requested permit or lieense requires Council actio�a to app�rove,soiaae iiaformation may become <br /> public. <br /> 5. Xou bave certain rights under M.S. 13.04(available upon request)to review private data on yourself. • <br /> 6. Your fuli name is rcquired to process tb�i�s applicatiio�a or�ermit. <br /> � 1/Yta j� � � ,� d r I a��� ql"e ,� <br /> Flrst Middle �� Last <br /> � (/��GtJ <br /> Addre� • <br /> _�t�j ,� 3'�3�� �'S'�i'��3—Ly�� . <br /> C1ry 5tace Zip P6one <br /> I uaderstsnd my ri ts as ststed above. <br /> 3i��natare <br /> � II I�� '°��I �Y 32 <br />