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r � <br /> r r <br /> Sec.13.04 RIGHTS OF S[JB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forrh in this section. <br /> Subd.2. Information required to be given indiridual. An individual azked to supply private or co�dencial data concerning himself <br /> shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,pofi[ical subdivision,or statewide <br /> rystem;(b)whe�her he may refuse or is IegaUy required to supply the requested data; (c)any lmown consequence arising from his supplying or <br /> refusing co supply privace or coofidenrial dara;and(d)the idenary of other persons or entides authorized by srate or federal law to receive the data. <br /> This requirement shail not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or nrooertv tax refund <br /> instructions!nstead of on those forms. <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 confidenrial. 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 hun and, if he desires, shall be informed <br /> of the content and meanin;of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be <br /> disclosed[o him for six months thereafrer uriless a dispute or acaon 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 priva[e or public data upon request by the individual subject of the data. <br /> The responsible au�horiry may require the requesring person to pay the actual cosu of making,certifyin�,and compiling the copies. <br /> 'Ihe responsible authoriry shall compty immediately,if possible,with any request made pursuant to this subdivision,or within five days <br /> of[he date of the request,excluding Saturdays, Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with <br /> [he request wi[hin that time, he shall so inform the individual, and may have an addidonal five days within which to comply with the request, <br /> excluding San:rdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accucacy or completeness of public or <br /> private dara concerning himself. To exercise this right, an individual shall no6fy in writing the responsible authoriry describing the nature of the <br /> disagreement. The responsible authoriry shail within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noafy <br /> past recipients of inaccurate or incompfete data,including recipiznu named by the individual;or(b)notify the individual that he believes the data <br /> [o bz correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The deterntination of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relaang <br /> ro 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 <br /> request for a permit or license from the City of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You are 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 tha[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 pernut or license requires Council action to approve, some information may become <br /> public. <br /> 5. You have certain rights under NI.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 /> ��� b t' v`'f ��V'- � �-e i <"f� r�t <br /> First �Stddle <br /> Last` <br /> --..���� �'rI i i1 i1 �.�"��` ,7 �C7 �'�'__i � �1 /�] '] tY 7 yl cry F <br /> Address � <br /> C� �-. „E� r�� /y � ��.� +�. �7 � r �'-t 7� -I y S 7 <br /> C�ry State Zip Phone ^ <br /> I understand my rights as stated above. <br /> -�`�-�.p � �,�- < --� � <br /> �ignature � <br /> 6 , <br />