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� <br /> Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA <br /> Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stocEd shall be as set for[h in this secdon. <br /> Subd.2. Information required to be given indiridual. An individual asked to supply private or confidendal data conceming himself shall <br /> be informed of: (a)the purpose and in[ended use of the requested data within the collecting'srate agency, polidcal subdivision,or statewide system; <br /> (b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying oc refusing to suppty <br /> private or confidential data;and(d)[he idenary of other persons or entities authorized by state or fedecal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesugative data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertV tax refund <br /> instrucrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whether it is classified as public, private or co�dencial. Upon his further request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown the data wi[hout any charge to hun and,'if he desires, shall be informed of the content <br /> and meaning of that data. After an individual has been shown the private data and informed of ia meaning,the data need no[be disclosed to him for <br /> six months thereafter unless a dispute or action pursuant to this secaon is pending or addirional data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry <br /> may require the requesting penon to pay the actual costs of 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 <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc <br /> within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Sarurdays, <br /> 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 private <br /> data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, including recipients named by the individual; or(b)no[ify the individual that he believes the data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administradve 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 pernut or license from the City of Orono or any of its departments may require you to fumish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The information you fumish will be used to determine your qualification for the pemut 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 permi[ 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 /> ��p t-4 tii ��,���� Y� f� �� ti�ti' v� � z_� �!� <br /> First Middle Last <br /> �� -� � ���,�� �- v� - �� � . <br /> >,�� �. <br /> Address �� ��—�_��'� � �"� �� ' �)���� � ���I�FA �� � ! � ( � <br /> W <br /> Ciry State Z�p Phone <br /> I understand my rights as sta d a�ove.i <br /> � # <br /> 1 , �� I <br /> Signature ' i "'�, <br />