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Sec.13.04 RIGFTTS OF SUSJECTS OF DATA ' <br /> Subd. 1. Type o[data. 71ie righcs of individual on whom the daa is swced or to be swcrd shalt be u sec forch ia ttiis secdoa <br /> � Subd.2. IatormatIoa nqvired to be given tadiv[dual. Art iadividual asYed w suppiy private or confideadal daa coccecniag himself sball <br /> be infocmed of: (a)the purpose aad iacended use of the zsquesred daa arichia the callecdng iate ageccy�polidai subdivisioc,or saoewide rysum• <br /> (b)whec�erlte tnay tefuse o'r is.le3ally requ'tr:d.co supply.the r.quesced dse:(cJ aay�sbwn coasequence uisiag ftvm his supplyiag ot reftuing w supp[y <br /> privac�or eon.sdcr.cai dara;and.(�c4e ideadry o[ocherpecsoas or earides auc�ocized by sri�e or fedeni law to teteive the dam. 'Ihi4 requiremee•s�all <br /> �not apply w�en an iedividuai is asked to dupply iavesrigadve daa putsuaac oo secdon 13.82.subdivisioa S,oo s Izw enfatcemeac ofRee�. .� . • <br /> 'he ceramissioner of revenus mav vlace che nodce r�uir.d under diis subdivision in the individual income eaz or orooeccv taz refund <br /> instrueaons inscead of on chose[ocnu. • � � <br /> Subd.3. Aecas to data bp iadivtdual. Upon requac w a responsibte aurhoriry.aa iadividuaI shall be infortned whe�hec he is ehe subjecc <br /> e[stor:d daa on iadtviduals.aad whecher it is elass�ed as pubGc.pcivate occonFdeadal. Upon his tticther request,aa iedividual wko is the subjecc <br /> of sioad privace or public daa on tadividuaIs shal!be shown che daa wichaut any charge oo him and,'if he dairu,shail be infocmed ot the coatenc <br /> aad meaaing o!thu daa. Aher an Individual has 6eep shown the priva�e dan and informed o[tcs meaaiag.the daa aeed not be disclosed oo him for <br /> siz moadu theceahe�nnless a dispute or icdon pursuanc to ehis secdon is pending or addidoeal daa on the individual has beea eollecc:d or crea�sd. <br /> T'he tesponsibie authoriry shall provide eopies ot the privacs or pubtie daa upon request by the individual su�jat o[che daa. 11ie respoasi'bie authoriry <br /> may requice the requesdng pecson oo pay che accual cosu of making,cecdfying,and compiling the copiu. <br /> The nsponsible auchoriry shall eomply immediscety,if possibte,wi�h any cequac made pursuuu m ehis subdivision,ar wi�hin Bve days of <br /> the da�e of the ceques�exdudiag Saturdays.Sundays and legal hotidays,if imcned'uce wmpliaace is not possible. If he eanaot comply widi the cequesc <br /> wiehin that dme,he shall so ictform the individnal,and may have an addidona!fve days�vi[hin�which ro co�npty wich the reques4 exdudin'g Saturdays, <br /> Sundays aad legal hotIdays. ' . , . . <br /> Subd.4. Pzoeedure whw data t�not accurate or eomplete. M tadlvidual tnay eontest the accunry or completeaeu of public or private , <br /> daa eoncecning tiimsdf. To exercix this right,an ir�dividuai shill nodfy ta wrideg the cespoas►ble authoriry dacdbing the naaice o[the ditagreemeac <br /> The re�poosible auchoriry shall within 30 days eieher. (a)comecc che dan fouad to be inaceucdte or iacomptete aad attempc to nodfy pasc tecipienes of <br /> inaccunce oc incamptece daca,inctuding recipienes named by the individuat:or(b)aoafy the individual tLac he believes[he data to be correct Dan <br /> In dispuce shall be disdosed oaly i!the individaal's stacerrcenc o[disagreemeat is induded wi�the disdosed data. <br /> The decernuJta�io�c'af�tHHt-�spop�'b{�auchoriry may be appealed pursuuu to the pr8;`isions of[he adminisaadve pcocedure ut reladng to <br /> contesred cases. � s �' .. � • �, ,�� r i',�� ; - • <br /> '� �•y`�.�. '=�,--�;�-.i�AT�A PRIVACX�1Ali�ffiQ�t�,�� t. / �.� `�:•� <br /> • � 1 'f: :�!�';' :-��:,��,;�J�1 � <br /> In accordance with M.S. 13.04,Subd.2, "Rir,,hu of subjecu of data",we would lil�to inform yb�t that your request <br /> for a permit or license from the Ciry of Orono or any of ics departments may require you to furnish certain private or <br /> confidential information. <br /> You aze notified t$at: <br /> a <br /> 1. The infocmai���:u�fii'tmj�sh',w'�tl�b�u�ed�tar�le{erm aepaut�ualfficadon for the permit orlicense requested. <br /> 2. You may refuse to suppiy data, but refusal may requ`ire tha�the Ciry deny the permit or license. � � <br /> 3. Zhe information may be shared with ocher loeal�state or federal agencies to the extenc necessary to process ', <br /> the permit or license. � <br /> 4. If your requested permit or license requires Council actioa to approve, some iaformation may become � <br /> . public. � � . . . . � <br /> 5. You have certaia rights under M.S. 13.04�(available upon request) to review private data on.yourself. . ' <br /> 6. Your full name is required to proc�ss this applicacion or permi�. <br /> �c�� ��e��M� <br /> Fust _ �ZZ,Z��t.d�� � _/J(!� �t ' — <br /> �d�� . ' ' LZ�. <br /> � <br /> Cicy . Sace � Zip Phone <br /> w � <br /> .'�I�' �,� _ , <br /> I undastand '� 5t �ed ove . . ' " -_, ,r; <br /> Signaa <br /> �� - <br /> '} <br /> t <br />