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� , � <br /> Sec.13.04 RIGI3TS OF S[JB,TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secaon. <br /> Subd.2. Information required to be given individual. An individual asked m supply private or co�denaal data conceming himself <br /> shall be informed of: (a)the purpose and inteaded use of the requested data within the collecting state agency,political subdivision,or statewide <br /> rysum;(b)whether he may refuse or is IegaUy required to suppty the requesud data;(c)any lrnown consequence arising from his suppiying or <br /> refusing m supply private or confidenrial daa;ac�(d)the idenary of other persons or enades authorized by srare or federal law m receive the dara. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision S, ro a law <br /> enforcement officer. <br /> The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income taz or orocerN tax refund <br /> instrucdons►nstead of on those fortns. <br /> Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the <br /> subject of stored data on individuals,and whether it is classified as public,private or co�dendal. Upon his further request,an individual who <br /> � is the subject of stored private or public data on individuals shall be shown the data without any charge ro him and,if he desires,shall be informed <br /> of the contenc and meaning of that data. ARer an individual has been shown the private dara and informed of iu meaning,the data need not be <br /> disclosed to him for six mond�s thereaher unless a dispute or acdon pursuant W this secaon is pec�ding or addiaonal data on the individual has been <br /> collected or created. The responsible authority shali provide copies of the priva[e or public dard upon request by the individual subject of the data. <br /> The responsible auchoriry may require the requesring person to pay the actual cosu of making,certifying,and compiling[he copies. <br /> Tha responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days <br /> of the dace of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy with <br /> [he request wichin that ume,he shall so inform the individual,and may have an additional five days within which to comply wi�the request, <br /> excluding Samrdays,Sundays and Legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest ihe accuracy or completeness of public or <br /> private data concerning himself. To exercise diis right,an individual shall aotify in wridng the nsponsible authoriry describing the nature of the <br /> disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found oo be inaccurate or uuomplete and aaempt to noafy <br /> pazt recipients of inaccurate or incomple[e dara,including recipirntc named by the individual;or(b)noafy the individual that he believes the daa <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisQative procedure act reladng <br /> to contesud cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a permit or license from the �iry of Orono or any of its departments may require you to fumish certai.n <br /> private or confidential information. <br /> You are notified that: <br /> 1. The information you furnish will„�e used to determine your qualification for the permit or license <br /> 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 with other local, state or federal agencies to the eztent necessary to <br /> process 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 on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> J- — <br /> F�rsc Middle Last <br /> �o S� � S I-�✓44e�r,v ��4n.� <br /> Address <br /> C�t���s�5�- �h- �3n �S-/o�� <br /> ���Y State Zip Phone <br /> I understand my rights as stated above. <br /> ��/� <br /> Signature <br /> � 6 <br />