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Sec.13.04 RIGHTS OF Si�CBJECTS OF DATA <br /> Subd.1. Type ot data. The rig6ts of lndividual on w6om the data is stored or to be stored shall be ss set forth In this sectioo. <br /> Subd.2. Information required to be given individual. An indlvidual ssked to supply private or conIIdential data concerning hlmself s6all be <br /> informed of: (a)t6e purpose and intended use of the requested data withio the collecting stste agency,political subdlvision,or statewide system;(b) <br /> whether 6e may retuse or ls legally required to supply the requested data;(c)any knowo rnnsequence arising from 6is supplying or refusiag to supply <br /> private or rnntidential data;and(d)the identity of other persons or entities suthorized by state or federal law to receive the data. This requtrement s6a11 <br /> not apply w6en an individual is asked to supply investigative data,pursuant to section 13.82,subdivlsion 5,to a law enforcement otticer. <br /> The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or orouertv tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by indivldual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> stored data on individuals,and whether it ls classified as public,private or contidential. Upon his further request,an individual who is the subject of <br /> stored private or public data on individuals shall be shown the data without any charge to him and,if 6e desires,shall be informed of the content and <br /> mesning of that data. After an tndividual6as been shown the private data aad informed of lts meaning,t6e data need not be disclosed to him for sta� <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been colleMed or created. The <br /> responsible authority shall provide rnples of the private or public data upon request by the individual subject ot the data.The responsible author(ty may <br /> require t6e requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> T6e responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivislon,or withln five days of the <br /> date ot the request,excluding Saturdays,Sundays and legal holldays,if immediate compliance is not possible.If he cannot rnmply with the request within <br /> that time,he shall so inform the individual,aad may have an additional five days within which to comply with the request,excluding Saturdays,Sundays <br /> and legal holidays. <br /> Subd.4. Procedure w6en data is not accurate or complete. An individual may contest the accuracy or completeness of public or privste data <br /> concerning himselL To eaercise this right,an individual shall notify in writiog the responslble authority descrlbing the nature of the disagreemenG T6e <br /> responsible aut6ority s6a11 wit6in 30 days either: (a)correct t6e data found to be ioaccurate or incomplete and attempt to notify past reclpients of <br /> inaccurate or inrnmplete data,lncluding recip(ents named by the individual;or(b)notify t6e individual that 6e believes the data to be correct. Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the dlsclosed data. <br /> The determination of the responslble authority may be appealed pursuant to the provisions of the administrative procedure act relating to <br /> contested 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 City 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 furnish will be used to determine your quaGfication 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 with other 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 permit. <br /> �0 �'� '�'1 �FG/�L�' <br /> First Middle Last <br /> 02�� 1 � 7' b�� ��vv,� ��SP' <br /> Address <br /> ,�l�o �� � 1'yi�/. �"s 3 C�( �s� � Yo� -- 9,7 S' <br /> C�tY State Zlp �— Phone <br /> I understand my rights as stated above. � <br /> Signature <br />