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� <br /> � <br /> Sec.13.04 RIGHTS OF SUB.TECTS OF DaT�. <br /> Subd. 1. Type of data. "Ihe righcs of individual on whom the data is stored or to be stored shall be as sec for[h in this secuon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidendal data conceming himself shall <br /> be informed of: (a) the purpose and incended use of the requesced dara within the collecang'stat�agency,policical subdivision,or sratewide rystem; <br /> (b)whether he may refuse oY is legaliy required co supply the requested data;(c)any 1a�own consequence arising from his supplying or refusing to supply <br /> • privace or confidendal data;and(d)the idenriry of other persons or endoes auchorized by state or federal law to receive the data. This requirement shall <br /> no[apply when an individual is asked to supply invesri¢adve dara, punuanc to secdon 13.82, subdivision 5, to a(aw enforcemen[officer. - <br /> The commissioner of revenue mav place the noace reauired under[his subdivision in the individual income tax or propertv tax refund <br /> inscrucrions insczad of on chose forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject <br /> of stored data on individuals,and wherher ic is classified as public, private or confidenaal. Upon his further request,an individual who is the subjecc <br /> of stored privace or public data on individuals shail be shown[he data wichouc any charge to him and,�if he desires, shall be informed of the content <br /> and meaning of chat data. Afrer an individual has been shown the privace data and infoaned of its meaning,the data need not be disclosed to him for <br /> six monchs eherealter unless a dispute or acdon pursuan�to [his secrion is pending or addidonal data on the individual has been collecced or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry <br /> may require the requesdng person to pay the accual coscs of making, cervfying, and compiling the copies. <br /> The responsible authoriry shall comply immedia[zly, if possible, with any request made pursuant to this subdivision,or within five days of <br /> the date of che request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is noc possibie. If he cannot comply with the requesc <br /> within rhat time,he shall so inform the individual,and may have an addidonal five days within wtuch to comply with the request,exctuding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest thz accuracy or completeness of public or private <br /> data concerning himsetf. To exercise this right,an individual shall noafy in wriang the responsible authoriry describing[he nature of the disagreemen[. <br /> The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomple[e and attempt[o nodfy past recipients of <br /> inaccurate or incomplece data, including recipients named by the individual; or(b)nodfy the individual tha�he believes the data to be correcc. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreemen[is included with the disclosed data. <br /> The determination of the responsibte au[horiry may be appealed pursuant to the provisions of[he admuuscrarive procedure act relaang to <br /> contesced 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 request <br /> for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The information you fumish 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 (availabie upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> ,� <br /> J aN Jv.��Pn ����;��,�.� <br /> Firsc �tiddle Last <br /> i �s7 i�r�213 1nIAy <br /> Addressr��v�P./ �f tt/ J ._`7 1�Z l`����%l'- n�i G� <br /> C <br /> Ciry Stare Zip Phone <br /> I understand my�hts as stated above. <br /> �,ii �c../ vi ,� <br /> , <br /> Signa[ure <br />