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c <br /> a <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd.l. Type of data. T6e rights of ladividual on whom the data Is stored or to be stored shall be as set forth in this sectioo. <br /> Subd.2. Information required to be given individual. An indlvidual asked to supply private or rnnfidential data concerning himself shall be <br /> informed o[: (a)the purpose and intended use of the requested data withln the collecting state agency,political subdlvision,or statewide system;(b) <br /> whether 6e may refuse or is legally required to supply the requested data;(c)any known rnosequence arising tmm his supplying or refusing to supply <br /> private or coaRdential data;and(d)the identity of other persons or entltles authorized by stste or federal law to recelve the data. T6is requirement shall <br /> not spply when an indlvidual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement otticer. <br /> The rnmmisstoner of revenue maY nlace the notice reauired under this subdivision in the individusl income tax or urooertv tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by Individual. Upon request to a responsible authority,an individual shall be informed whet6er he Is the subject of <br /> stored data on individuals,and whether it is classitied as public,private or contldentill. Upon his furt6er request,an individual who is the subject of <br /> store8 private or public data on individuals shall be shown the�data without any charge to him snd,lt he desires,shall be informed of the content and <br /> meaning oi that data. After an Individual has been s6own the prlvate data and informed of its meaning,the data need not be disclosed to him tor six <br /> mont6s thereatter unless a dispute or action pursuant to this sectio�is pending or additional data on t6e individual has been collected or created. T6e <br /> responsible authority shsll provide rnples of the prlvate or public data upon request by the indivldual subJect of the data. T6e responsible aut6ority may <br /> require t6e requesting person to pay the actual costs of making,certifying,and compiling the copies. . <br /> The responsible authority shall comply immediately,if possible,wlth any request made pursuant to this subdivision,or within five days of the <br /> date of t6e request,excluding Saturdays,Sundays and legal holidays,if Immediate compllance is not possible.I[he caneot rnmply wit6 the requestwithln <br /> tNat tlme,he shall so inform the individual,and may have an addittonal five days within which to comply with the request,excluding Saturdays,Sundays <br /> and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete.Aq individual may contest t6e accuracy or completeness of publtc or private data <br /> concernIng himselL To exercise this right,an indlvidusl shall notify in writing the responsible authority describing the nature of the dlsagreemen� The <br /> responsible authorlty shall within 30 days either: (a)correct the data found to be Inaccurate or inrnmplete and attempt to notify past recipients ot <br /> inaccurate or inrnmplete data,Including recipients named by the individusl;or(b)nodfy the individual that 6e belleves the data to be correct. Data in <br /> dispute shall be disclosed only if the indlvidual's statement of disagreement is lncluded with the dlsclosed data. <br /> T6e determination ot the responsible suthority may be appealed pursuant to the provisions of the administrative procedure aM 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 informarion. <br /> You are 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 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 requ' to proces lication or permit. <br /> C� � �( <br /> First Middle <br /> I ��� �� . Last <br /> 7(/ /.�t��/.f � U�� � <br /> Address ` '—�`{ � ����� <br /> � r-�. � ., � �it� �3�`P . r.�� �`r� �G6� <br /> City State Zip Phone �— <br /> I understa ri ts as stat d a ove. . <br /> Signature <br />