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t� - <br /> Sec.13.0�1 RIGHTSOFSUBJECTSOFDATA <br /> Subdivision 1. Type oJdata. The rights of individua!on ivhom the data is stored or to be stored shall be as set jorth rn this s�ction. <br /> Subd.2. Injormation required to be given individuaL An individua!asked to supply prrvate or confidential data concerning himselj <br /> shall be injormed of.• (a)the purpose and rntended use of the requested data within the collecting state agency,political subdrvisron,or statetivrde <br /> system;(bJ whether he may refuse or is lega!!y required to supply the reguested data;(cJ any knotivn consequence arising from his supplyrng or <br /> refusing to supply private or confrdential data;and(d)the identiry of other persons or entitres authorized by state orfederal laiv to receive the data. <br /> Thrs requirement shall not apply tivhen an indrvidua!is asked to supply investigative data,pursuant to sectron /3.82, subdivision S, to a lativ <br /> enjorcement oJficer. <br /> The commissroner ofrevenue may place the notice requrred under thrs subdivisron in the indivrdual income tax or property tax rejund <br /> instructions rnstead ojon those rorms. <br /> Subd.3. Access to data by individua[. Upon request to a responsrble authorrty,an indivrdual shall be informed whether he is the subject <br /> of stored data on rndividuals, and whelher it is classrfied as public,private or confidential. Upon his further reguest,an individual who is the <br /> subject olstored private or publrc data on indrviduals shall be shoivn the data ivithout any charge to him and, if he desrres,shall be injormed of <br /> the conlent and meaning of that data. Ajter an ixdividua!has been shotivn the prrvate data and informed of its meaning, the data need not be <br /> diselosed to him for six months thereajter unless a dispute or action pursuant to thrs section is pendrng or additronal data on the rndividua!has <br /> been collected or created. The responsible authority shal!provide copies of the private or public data:�pon request by the indrvidual sirbject oj <br /> the data. The responsrble authority may require the requesting person to pay[he actua!costs ojmaking,cerl�ing,and compiling the copies. <br /> The responsible authorrry shall camply immediately,rfpossible,with any request made purs:rant to this s:�bdivision,or ivilhin five days <br /> ojthe date of the request,excluding Saturdays,Sundays and legal holidays,f rmmediate compliance is not possible. If he cannot comply ivith the <br /> request u ilhin that time,he shal!so injorm the individual,and may have an additional frve days ivithin whrch to comply tivith the request,excluding <br /> Saturdms,Sundays and lega!holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness ofpublrc or prrvate ' <br /> data concerning himselj. To exercise this rrght, an rndividual shall nolify in writing the responsible authorrty describing the nature oj the � <br /> disagreement. The responsrble authoriry shalllvilhin 30 days either: (a)correctlhe datafound to be inaccurate or incomplete and attempt to notijy <br /> past reciprents of inaccurale or incomplete data,including reciprents named by the rndividual;or(b)not�the indivrdual that he believes 1he data � <br /> to be_orrect. Data in dispute shall be disclosed only ijthe rndividt�al's statement of disagreement is included tivith the disclosed data. <br /> The determrnation of the responsi6le authority may be appealed pursuant to the provisrons ojthe administrative procedure act refating <br /> to contested cases. <br /> DATA PRIVACYADV/SORY <br /> In accordance u•ith M.S. /3.Oa,Subd.2, "Rights ofsubjects ofdata",ive would like to inform you thnt your requestfor a permit or license <br /> from the Ciry of Orono or any of its departmenls may require you to furnish certain private or conjidentia!information. <br /> You are notified that: <br /> l. The rnjormation you furnish ivill be used to determine your qualifrcation for Ihe permit or license req:�ested. <br /> 2. You may rejuse to supply data, but re,jusa!may require that the Crty deny the permit or license. <br /> 3. The injormalron may be shared wrth olher local,stale or federa!agencies to the exten!necessary to process the permit or <br /> license. <br /> -1. /f your requested permit or license requires Co:mcil aclion to approve,some information may become public. <br /> S. You have certain rights under M.S. 13.0�1(see follotiving page)to revietiv private data on yourselj. <br /> 6. Your ful!name is required!o process this application or permit. <br /> PLEASE PRINT <br /> j�'/�E�T' � ������ <br /> First Middle Last <br /> yG'/ �i��'✓ �1�E �T, <br /> Address <br /> �%�yZ�T�' l�'li�� ��-3�/ �-$z``�>s= 3 3�I� <br /> Ciry State Zrp Phone <br /> . <br /> 1 under n my ights as�ta d a . <br /> ..c .r-s�/` <br /> Signature � <br /> /0 <br /> 4 <br />