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Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or ro be stnred shall be u sec fo�th in this secdon. <br /> Subd.2. Information reqirired to be givw indiridual. An individuai asiced w supply private or confideatial daa coacemiag himself shall <br /> be informed of: (a)ehe purpose and inrended use of the tequuud data within the collecting Stace agency,polidcal subdivision.or seatewide rystem; <br /> (b)whe�her he may refuse ot is legally required co suppiy the mquesud data:(c)any Imown consequence arising from tus supplying or refusing to supply <br /> priva[e or confidendal dara;and(d)ehe idendry of other persoas or enudes aurhorized by state or federal law to rnceive the data. This requiremenc shall <br /> not apply when an individual is asked to supply iavesdgadve da�a,pursuant ro secdoa 13.8?,subdivision 5,to a law enfocsement ofFcer. <br /> The commissioner of revenue mav vlace the nodce ceauired under this subdivision in the individual income rax or orooertv taz refund <br /> insccucrions inscead of on chose forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stocrd data on individuals,and whether it is classified as public,private or confidendal. Upon lus further request,an individual who is the subject <br /> of storai private or public dara on individuals shall be shown che dara wirhout any charge W him and;if he des'ues,shall be informed of the content <br /> and meaning of[hat daa. After an individual h�t becn shown che private dan and informed of ics meaniag,the data need not be disclosed ro him for <br /> six monchs rhereafter unless a dispute or acdon pursuanc to ehis secdon is pending or addidonal dara on che individual has been collected or creamd. <br /> The responsible aurhoriry shal(provide copies of the private or public data upon reqnest by rhe individuai subject of[he dara. 'Ihe responsible authoriry <br /> may require the requesting person ro pay the accual coscc of makinz,cectifying,and compiling the copies. <br /> The responsible au[horiry shall comply immediately,if possibie,with any request made pursuant to[his subdivision,or wi[hin five days of <br /> the date of die request,excluding Saturdays,Sundays and legal6olidays,if immediace compliance is not possible. If he cannot comply with the request <br /> wichin rhac ame,he shall so inform the individual,and may have an addiaonal five days within which to compiy wich the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accnrate or complete. An individual may contesc the accuracy or completeness of public or private <br /> data conceming himself. To exercise this right,an individual shall nodfy in wridng[he responsible auchoricy describing the nature of the disagteement. <br /> The responsible auchoriry shall wiehin 30 days either: (a)correct ehe data found to be inaccucate or incomplete and attempc to nodfy past rocipiencs of <br /> inaccurace or incomplece data,including recipiencc named by ehe individual;or(b)noafy the individual thac he believes ehe data to be correct Data <br /> in dispuce shall be disclosed only if the individual's statement of disagnement is included with the disclosed data. <br /> The decerminadon of che responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act nlaang to <br /> conusud cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "RiQ,,hts of subjects of data", we would like to inform you that your request <br /> for a pemut or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidencial information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determi.ne your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. <br /> 3. The information may be shazed with o[her local, state or federal agencies to the eztent 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 on yourself. <br /> 6, Your full name is required to process this application or permi[. <br /> � �e� � �� <br /> � First Middle Last <br /> Z� Z � � �c ��C� ������ <br /> Address „ A 1 ���� � �/ � / _ ( �� � <br /> �7C ������'��Z� ww —t' L <br /> Ciry Sace Z�p Phone <br /> r <br /> I understand my rights �s scated above. � <br /> \� <br /> Signaturo <br />