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, f <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type o[data. The rights of individual on whom the data is stored or W be stored shali be as set forth in this secdon. <br /> Subd.2. Infonnation required to be given individusl. An individual asked w supply private or confidential data concerning himself <br /> shall be informed of: (a)the purpose and inoended use of the requested data within the collecting state agency,polidcal subdivision,or statewide <br /> system;(b)whether he may refuse or is legally rcquind m supply the requested data;(c)any known consequence arising from his supplying or <br /> refusing to supply private or confidential data;and(d)the identiry of odur persons or endties authorized by state or federal law to receive the data. <br /> This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law <br /> enforcement officer. <br /> The commissioner of revenue mav nlace the rrotice reauircd under this subdivision in the individual income tax or nronertv tax refund <br /> instrucrions instead of on those fortns. <br /> Subd. 3. Access to data by individusl. Upon request to a responsible authoriry,an individual shali 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 privare or public data on individuals shall be shown the data without azry charge to him and,if he desires,shall be informed <br /> of the content and meaning of that data. After an individual has been shown the privau data and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individuat has been <br /> collected or created. The responsible authority shall provide copies of dx private or public data upon request by the individual subject of the data. <br /> The rosponsible authoriry may require the requesring person to pay the scmai costs of making,certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately,if possible,with azry ra�uest made pursuant to this subdivision,or within five days <br /> of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliar�ce is not possible. If he cannot comply with <br /> the request within that dme,he shall so inform the individual,and may have an additional five days within which w comply with the request, <br /> excluding Saturdays,Sundays and legal holidays. � <br /> Subd.4. Procedure when data is not securate or complete. An individual may contest the accuracy or completeness of public or <br /> private data cor�eming himsetf. To exercise this right,an individual shall norify in wridng the responsible authoriry describing the nature of the <br /> disagreement. The responsibie suthority shall within 30 days either: (a)correct du data found to be inaccurate or ir�complete a�d attempt to notify <br /> past recipients of inaccurate or incomplete da�,including recipients named by the individual;or(b)notify the individual that he believes the data <br /> to be correct. Data in dispute shall be disclosed oNy if the individual's statement of disagroement is included with the disciosed data. <br /> The determination of the responsible authoriry may be appealed pursuant W the provisions of the administrative procedure act relating <br /> to 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�ity of Orono or any of its departments may require you to furnish certain <br /> private or confidential information. <br /> You ue 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 Ciry deny the permit or license. <br /> 3. The information may be shazed with other local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> � 4. If your requested permit or license requires Council action Eo 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 /> u►�� Aii��� �7���So,� <br /> First Middle I.ast <br /> -7 i� ,�c/ �An� �� <br /> Address <br /> .�,uo /!�!�/ '�/75-3 95"7 <br /> C�ry State Zip Phone <br /> I understand my rights as stated above. <br /> � ' <br /> Signature <br /> 6 <br />