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�� � , <br /> Sec.13.04 RIGFiTS OF SCTB.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 forth in this secaon. <br /> Subd.2. Information reqirired to be given individual. An individual asked to supply privare or co�dendal data conceming himself <br /> shall be informed of: (a)the purpose and incer�ed use of the requested data within the collecting state agency,polidcal subdivision,or statewide <br /> sysum;(b)whether he may refuse or is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or <br /> refusing to supply private or confidenaal data;aad(d)the idenary of other persons or enddes authorized by srate or federal law to receive the data. <br /> This requirement shall not apply when an individual is asked to supply invesrigadve data, pursuant to secdon 13.82, subdivision 5, to a law <br /> enforcement o�cer. <br /> � The commissioner of revenue mav olace the norice roauired under this bdivision in the individual income taz or o ertv tax refvnd <br /> instrucdons instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,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 confidenaal. Upon his further request,an individual who <br /> is the subject of stored private or public data on individuals shall be shown rhe dara without any ct�arge 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 private data and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secaon is pending or additional data on the individual has been <br /> collected or created. The responsible authoriry shall provide copies of the private or pubtic data upon request by the individual subject of the data. <br /> The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. <br /> 'Iha responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days <br /> of the date of the request,excluding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with <br /> the request within that time,he shall so inform the individual,and may have an additiona!five days within which to comply with the request, <br /> excluding Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or <br /> private data concerning himself. To exercise this right,an individual shall nodfy in writing the responsibie authoriry describing the tiature of the <br /> disagreement. The responsbte authoriry shall within 30 days eid�er: (a)correct the data found to be inaccurate or incomplete and aaempt to noafy <br /> past recipiencs of inaccurare or incomple[e dara,inc(uding recipients named by the individual;or(b)notify the individual that he believes the data <br /> m be coaect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determina6on of the responsibie authoriry may be appealed pursuant w the provisions of the adminisuaave procedure act relating <br /> to contested cases. <br /> pATA PRIVACY ADVI ORY <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 ��ty 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 that 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 permit or license. <br /> 4. If your requested pemut 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 /> �av�i�c� 1�, i-Eaol� v�� <br /> F�rst Middle �� <br /> �`Jq O l�d r{-� �rt�vi �r t e� <br /> Address <br /> �rov�o �it�1 55�� �5 2� 7Z-36�b <br /> C�ry State Zip Phone <br /> I understand my rights as stated above. <br /> Signam , , <br /> 6 � • <br />