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i • <br /> Sea 13.04 RIGHTS OF SUB.TECTS OF D�TA <br /> Subd, i. 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 private or confidendal data concerning himself sha11 <br /> be informed of: (a)�he purpose and intended use of the requested data within the collecring"state agency, poliacal subdivision,or statewide system; <br /> (b)whether he may refuse or is legally requimd co supply rhe requested data;(c)any Imown consequence arising from his supplying or refusing to supply <br /> private or confidendal data;and(d)the idendry of other persoas or enrides autborized by state or federal law to receive the dara. This requirement shall <br /> not apply when an individual is asked to supply invesrigarive data, pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. <br /> The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propertv 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 inforraed whether he is the subject <br /> of stored data on individuals,and whecher it is classified as public, private or co�denaal. Upon his further request,an individual who is the subject <br /> of stored private or public data on individuals shall be shown che data wi�hout any charge to him and:if he dzsires, shall be informed of the content <br /> and meaning of that dara. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hirn for <br /> six monrhs thereafter unless a dispute or acnon pursuanc to this secaon is pending or addidonal data on the individual has been coliected or created. <br /> The responsib(e authority shall provide copies of the private or public data upon request by the individual subject of rhe data. The responsible authoriry <br /> may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. <br /> The responsible au[horiry shall comply immediately, if possibfe, with any request made pursuant to this subdivision,or within five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he caanot comply with the request <br /> within that time,he shall so inform the individual,and may have an addiooaal five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An mdividual may contest the accuracy or completeness of public or private <br /> data concerning himself. To exercise this right,an individual shail nodfy in wridng the responsible authoriry describing[he nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct che data found to be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipients named by[he individual; or(b)nodfy the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statemen�of disagreemenc is inciuded with the disc(osed data. <br /> The decermination of the responsible authority may be appealed punuant to the provisions of the administrarive procedure act reladng to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you tha[your request <br /> for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> i. 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 pemut or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent 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 required to process this application or permit. <br /> V� Z-t'�.,��J � G`�'1 l �� G <br /> First Middle � �� Lasc <br /> S'� �7 � L�G��.c�;� �` iii�� <br /> Addre�5 - <br /> r��1 �� 11y� F��� ��-���y L�� -��- �s��� <br /> City Srate Zip Phone <br /> I und tand my rights stated a ove. �� <br /> �_� ` �� <br /> � <br /> , "�� <br /> Signature <br />