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� <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA ' <br /> Subd.l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. <br /> Subd.2. Intormation required to be given individual.An individual asked to supply private or confidential data concerning himself shall be <br /> informed ot: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity otother persons or entities authorized by state or federal law W receive the data.This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law eniorcement officer. <br /> The commissioner ot revenue mav olace the notice reauired under this subdivision in the individual income tax or nroaertv tax refund <br /> instruMions 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 subject of <br /> stored data on individuals,and whether it is ciassified as public,private or confidential. Upon his further request,an individual who is the subject of <br /> stored private or public date on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and <br /> meaning of that data. After an individual has been shown the private data and informed o[its meaning,the data need not be disclosed to him tor six <br /> months thereafter unless a dispute or action pursuant to t6is section is pending or additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public data upon request by the individual subjeM of the data. The responsible authority may <br /> require the requesting person to pay the aMual costs ot making,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the <br /> date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within <br /> that time,he s6a11 so inform the individual,and may have an additional£ve days within w6ich to comply with the request,excluding Saturdays,Sundays <br /> 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 private data <br /> concerning himselL To exercise t6is rig6t,an individual shall notify in writing the responsible authority describing the nature ott6e disagreement The <br /> responsible authority shall within 30 days either: (a)correct the data tound to be inaccurate or incomplete and attempt to notlfy past recipients of <br /> Inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes t6e data to be rnrrect. Data in <br /> dispute shall be disclosed only if the individual's statement oi disagreement is included with the disclosed data. <br /> T6e determination o(the responsible authority may be appealed pursuant to the provisions of the administrative procedure act 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 egtent 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 yourseif. <br /> 6. Your full name is required to process this application or p 't. <br /> � G�t� �'- t�L so N <br /> First Middle La <br /> �,��-O � � `J D <br /> Address <br /> �t.� 'S'-,4- �l�Z - `�9' -��� /a/� <br /> CjtY State Zip Phooe <br /> I understand my lrts a sta e. <br /> :' <br /> Signature <br />