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� . <br /> � <br /> Sec.13.04 RIGHTS OF SiJB.TECTS OF DATA <br /> Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Information required to be given indiridual. An individual asked to supply private or co�dential data conceming himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or stacewide <br /> rystem;(b)whether he may refuse or is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or <br /> refusing to supply private or confidendal dara;and(d)the idendry of other persons or entides authorized by srate or federal law to receive the dara. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secrion 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> 'Ihe commissioner of revenue mav Iace the nocice re ired under this subdivision in the individual income taz or ro em tax refund <br /> instrucdons instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authority,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�denrial. 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 to him and, if he desires,shall be informed <br /> of the content and meanin�of that data. Aher an individua!has been shown the private data and informed of iu meaning, the data need not be <br /> disclosed to him for six months thereafrer unless a dispute or action pursuant to this secrion is pending or addidonal data on the individual has been <br /> collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. <br /> The responsible aurhority may require the requesring person to pay the actual costs of making,certifyin„ and compiling the copies. <br /> The resporuible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days <br /> of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> the request wi[hin that time, he shall so inform the individual, and may have an additional five days within which to comply with the request, <br /> excluding Saturdays, Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or <br /> private dara concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the namre of the <br /> disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify <br /> past recipienrs of inaccurate or incomplete dara,including recipienu named by the individual;or(b)nocify the individual that he believes the data <br /> to be correct. Data in dispute shall be disclosed oniy if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of the respo�uible authority may be appealed pursuant to the provisions of the adminis�aave procedure act relating <br /> to contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance wi[h 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 �ity of Orono or any of its departments may require you to fumish certain <br /> private or confidential information. <br /> You aze notified that: <br /> 1. The information you furnish will be 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 extent necessary to <br /> process the pemut or license. <br /> 4. If your requested pemut 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 emut. <br /> �eo +1�1`� <br /> Firsc �/�� Middle (�,I <br /> � �� � o� 1 ''l �n�1 2 '� f�� YL.U � , Last <br /> A dress <br /> 1'>'1�. 5.�3�t �l z �f �t- S 1�f� �x� I I 6 <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> C( �+� l.J�-� � ((' A �,[ <br /> .. I�1 1 L.�� �C�J" <br /> $tg NtC <br /> 6 <br />