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� s e <br /> Sec.13.04 RIGHTS OF SUBJECrTS�O�DATA <br /> Subd.l. Type of data. The rlg6ts of Individual on whom the data Is stored or to be stored s6all be as set fort6 in thls sectlon. <br /> Subd.2. Informatlon requtred to be gtven individaal.An individual asked to supply prtvate or contidentlal data conceroing htmself shall be� <br /> informed of: (a)the purpose and intended use of the reqaested data within the collecUng state agency,polltical subdlvision,or statewide system;(b) <br /> whet6er he may refuse or is►egally requlred to supply the requested data;(c)any Imown consequence arising from his supplyfng or refusing W supply <br /> private or confldential data;and(d)the identlty of other persons or entlties aut6orized by state or federal law to receive the data.This requirement shall <br /> not apply when an individual is asked to supply Investigative data,pursuant to section 13.82,subdIvision S,to a law enforcement officer. <br /> T6e commisstoner of revenue mav olace the noHce reauired under this subdivision in the ladividual income tax or orooertv taz refund <br /> Instrucdons instead of on those forms. <br /> Subd.3. Access to data by Indlvtdual. Upon reqnest to a responsible author[ty,an individual shall be informed whether he is t6e subject of <br /> stored data on indtviduals,and w6ether it is classlfled as pablic,private or coatidential. Upon his further reqnest,an individual who is the subject of <br /> stored prlvate or pubHc data on individuals shall be shown ffie data wlt6out any charge to hlm aud,lf he dcslres,shall be informed of the content and <br /> meaning ot t6at data. After an individual has been shown the prlvate data and Informed of its meaning,the data need not be disclosed to him for sia <br /> months t6ereafter unless a dtspute or actlon pursuant to thLs sectton(s pending or add(tloaal data on the tadividual6as been collected or created. T6e <br /> responsible authority s6aII provide cop(es of the private or pabHc data upon reque.st by t6e indlviduai subJect of t6e data.The re.cponsible aut6orlty may <br /> require the requesdng person to pay t6e actual costs of maldng,certifying,and compiling the copies. <br /> The responsible authorlty shall comply immediately,if possible,w(th any request made pursuant to this subdivlsion,or wit6in ttve days of the <br /> date of the request,eacluding Saturdays,Sundays and legal holidays,if immediate compltance is not possible.If he cannot comply w(th the request within <br /> that Hme,he shall so inform t6e(ndlvidual,and may have an addittonal tive days wit6ln which to comply wit6 the request,eacluding Saturdays,Sundays <br /> and legal holldays. <br /> Subd.4. Procedure when data Is not accurate or complete. An individual may contest the accuracy or completeness otpublic or private data <br /> wncern[ag himself. To eaerclse this rlg6t,an ind[vidual shall notify[n writing the responsible suthority descrlbing t6e nature of the d(sagreemenw The <br /> responslble authorlty shall wit6ln 30 days eit6er. (a)correct the data found to be inaccurate or incomplete and attempt to notlfy past rec(ptents of <br /> Inaccurate or incomplete data,including recipieets named by the individual;or(b)notify t6e iudivtduai that he belleves the data to be correct. Data in <br /> dispute shall he disclosed anly!f the individual's statement of dLsagreement is included with the dlsdosed data. <br /> The determination of t6e r�ponsible aut6orlty may be appealed pursuant to the provtsions of t6e administrative procedure act relatlng 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 information. <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 bi.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 /> _�A L� �", �M G.G V,R•c�`� S L-1 I J�� � �', M �. C C! t�.�`t� <br /> Flrst ' Middle Last <br /> 40 �' l I11 �1kfi N �al�ldR.� bCZ1V� <br /> Address <br /> IVL �U N � . 1`�\ N e � ���� -L �� 'r� ! Z��� JJ <br /> C�tY State Zip Phone <br /> I understand my rights as stated above. . <br /> G � � � <br /> Signature <br />