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. � <br /> Sec.13.04 RIGHTS OF S[iBdECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on w6om the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information req�rired to be givw individual. An individual asked w supply private or confidendal data wncerning himself shall <br /> be informed of: (a)the purpose and intended use of the requested dara within the collecting§tate agency,polidcal subdivision,or statewide system; <br /> (b)whether he may refuse oY is legally required to suppty the requesud data:(c)any lmown consequence arising from 6is supplying or retusing to supply <br /> private or confidential data;and(d)the idendry of other persons or enddes authorized by state or federal law to receive the data. T'his requirement shall <br /> not apply when an individual is asked to supply invesrigadve dars,punvant to section 13.82,subdivision 5,w a law enforcement officer. <br /> The commissioner of revenue mav place che nodce rewired under this subdivision in the individual income tax or provertv caz rofund <br /> instcucaons instead of on those forms. <br /> Subd.3. Accas to data by individual. Upon request to a rosponsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuats,and whecher it is classified as public,private or confidendal. Upon his further reques4 an individuai who is the subjecc <br /> of stored private or public data on individuais shall be shown the data wi[hout any charge to him and,-if he desires,shall be iafocmed of the conten[ <br /> and meaning of rhat data. After an individual has bcen shown the private data and infocmed of its meaning,the data need not be disclosed to him for <br /> six months thereafur unless a dispute or acdon pursuant to this secdon is pending or additioaal data on the individua(has been collected or croated. <br /> The nsponsibie authoriry shall provide copies of�e private or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require�e roquesang person to pay the actual cosu of making.certifying,and compiling the copies. <br /> The responsible au[horiry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shail so inform[he individual,and may have an addidonal five days within wtuch to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accutacy or completeness of public or private <br /> data conceming himself. To exercise this right,an individual shall noafy in writing the responsibie authority describing the nature of the disagreement. <br /> The nsponsible authoriry shall within 30 days either. (a)correct the data found to be inaccurdte or incompleu and aaempt to notify past recipientc of <br /> inaccurate or incomplete daca,inctuding recipienrs named by[he individual;or(b)nodfy the individual that he believes the data to be correct. Data <br /> in dispute shail be disclosed only if the individual's statement of disagreement is included with rhe disclosed data. <br /> The determinaaon of the responsible authority may be appealed pursuanc to che provisions of the administcadve procedure act relating to <br /> contesud 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 aze notified that: <br /> 1. The information you furnish 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 Ciry deny the permit or license. <br /> 3. The information may be shued with other local, state or federal agencies 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 (available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> l�I �l l � ""(� <br /> Fint /M' iddle Lasc <br /> ��Q� � rJ 7G K ��'' � � <br /> Add � //� JV J.�'�oZ� �J�—��6 <br /> Ciry State Zip Phone <br /> I understand m ri hts as st above . <br /> ��J � � <br /> Signature <br />