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� <br /> Sec.13.04 RIGI�iTS OF SUBJECTS OF DATA ' <br /> Subd. 1. Type o[daca. 'Ihe righcs of individual on whom[he dara is scored or co be swred shalI be as set forch ia this secuon. <br /> Subd.2. Intormation reqlrired to he given indivfdual. �n individual asked to supply private or caafidendal dam concerning himself shail <br /> be infora:ed o�: (a)the purpase and incended use of the requested dan wichin the eollecang sratt agenty,goliacal subdivision,or smmwide rysum; <br /> (b)whe�er he raay refuse oY is_legally requir.d to supply che rquesud data;(c}any Iatown coascquence arisiag from his supplying or refusing tn supply <br /> privace or conndenoal daa;and(d)che ideadry of oeher per�oas or enodes au�orized by seace ar fedecal law[o rnceive che data. This requ'uemeac sha!I <br /> not apply when an ir.dividual is asked to supply invesdgarive daa,pursuan�ro secdon 13.82,subdivision 5,co a law enforaemenc o�cec <br /> 'Che eec�missioner of revenue mav DI3CC ih� nodc- rauird und-r this subdivision in the individuai income tax or orooem taz refund <br /> inscrucdons inscezd of on chose forms. <br /> Subd. 3. Access to data by individual. Upon requcsc co a responsible authoriry,an individual shall be informed whtther he u che subject <br /> of scor.d dan on individuais,and whecher it is class�:d as public,private or conhdenaal. Upon his funher request,aa indi�idual who is the subje:c <br /> of scored privace or public daa on individuals shall be shown che dam wichout any charge to him and;if he desires,shall be infocmed of the eoocanc <br /> and m�aning af that dara. After an individual has been shown the privare dac�and informtd of ics meaaing,the data need not be d'uclosed ro him for <br /> six mon[hs theceafrer uniess a dispuce or acdon pursuant to ttus secdon is pending or addidooal data on the individual has becn collecced or created. <br /> The cespacuibla auehoriry shall provida eopies of the privac�or public data upon request by the individual subjece oF che dara. The responsible auchoriry <br /> may require the requesdng person to pay che accual coscs oi makinz,cerdfying,and compiling the copies. <br /> 'Ihe responsible authoriry shal!comply immediattly,if possible,wich aay teques[made pursuant co this subdivision,or wi[hin five days of <br /> the dace of the requesc,ezcluding Sacurdays,Sundays and legal holidays,if immediate compliacce is not possible. If he canaot comply with the tequcsc <br /> wichin chat ame,he shall so inform the individual,and may have an addirioaal five days wi�hin which to comply wich the request,ezcluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public oc private <br /> data conceming himself. To exercise chis righc,an individual shail noafy in wridng che responsibie au�horiry describing the natuce of the disagreemeac <br /> The responsible auchoriry shall wi[hin 30 days eithet: (a)comct[ha da[a found to be inaccucat^or incomplece and aaempc co nadfy past recipiencs of <br /> inaccurnte oc incomplete data, including recipien�s named by the individuai;or(b)noafy the individual that he betieves the dara to be correct Data <br /> in dispuce shall be disclosed only if the individual's scacerr.enc of disagreement is included with the disdosed data. <br /> The decerminadon of the responsiblt auchoriry may be appealed pursuanc to the provisions of the adminisaarive procedure act rela[ing to <br /> contesced cases. � <br /> DATA PRIVACY ADVISORY <br /> In accordance wich 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 qualification for che permit or license requested. <br /> 2. You may refuse to suppty data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared wich ocher local, state or federal a;encies to the ettent necessary to process i <br /> the permit or license. <br /> 4. If your requested perm.it or licease requires Council action to approve, some information may become i <br /> public. j <br /> 5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. ' <br /> 6. Your full name is required to process this applicacion or permi�. <br /> � i <br /> j;_�:�; � � �.�;' ���� � ��� `, i <br /> Firsc �fiddl Lasc <br /> /�<�/ ��'.% 1���'���� /'�,�J ' <br /> Addreu <br /> /'�?�.!-�2 < � ,��?�' '��j jCi �� %��� ���J � <br /> Ciry Sate Zip Phone i <br /> I underst y ri;hts as stated above. <br /> GC�'�� ,' J�. �' . ( <br /> signa[ure <br />