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Sec.13.04 RIGfITS OF St1BTEC?S OF DaTA • � <br /> Sutd. i. Tyge oi data. The tighct of iadividual on whom thc daca is scored at oo be stor.d shalI be as set foah in t1�i.s secrion. <br /> 5ubd.2. Intormation req�rrd to be givea indtriduaI. �1n individuai uked to suppiy privam ur caafideaaal dam conceming himself shatI <br /> be in.°ora:ed o,`: (a)[he purpose acd iac.nded usa of[he requesc�dan wichin ehe eollecdng��m agency.policcal subdivision,or samwide ryztm• <br /> (b)whe4`.e:h_:.3y r_rus:or is_legalIy requir:d to supply.tfie r_qucsud daa;(c)aay Iciown eaasequcnce arisiag froa his supptyiag or refuing co supply . <br /> privace orea:i::der.caI data;ar.d(d)c�e idcndry of o�ergersoas orec3a:s au�orizcd by sc��or f:ac�':�::;;r_ceive�e da�. Th;s rquiremeat s�a1 <br /> not a�ply w•::ea an i:dividuaI is asked to supply invesaga¢ve dae,pursuanc co s<caaa 13.82,si:Mivision 5.co a law enfdccemeat ofncer. . . <br /> '[�e cenmissionec of revenu� mav oiace che nodc- r�uird und•r this subdivision in the individual ircome ez or orooem t�z refund <br /> instrucdoru Lnsread of an those forrsu. . —' <br /> Subd. 3. Aecess to data by individual. Upon request to a responsible auchoriry,an individuat shatl be inforzaed whether he is the subjecc <br /> of star_d dsa on individuaLs,and whe�her it is et�uiFied u public,private or eanF.dena�l. Upaa his turcher r_quesi,an individaaI who is th:subjecc <br /> oE stor:d priva;e or public data on individuaIs shali be shown ehe daa wichaut any charge w hiia and;if he desira,shall be infocmed o[the eoacent <br /> and meaning ef chat daa. Afu�an individuaI hic been shown the private daci ar.d informtd o[ics meaniag,the dam ne:d no�be discIosed to him for <br /> six monchs chereafter unless a dispute or acdon puesuanc co chis secdon is pending oc addidoaal da�on che iudividuaI has beea eolIecc:d or ercac�d. <br /> Tae cespansibie aa�hociry shaIl�provida eopies of che priva�:or public daa upon request by the individual subjecc of[he daa. Tha responsible authoriry <br /> may cequir. the r.quesdng peaon to pay the accual eosu o[m�kinz,eecafying,ar.d eompiling the eoQies. <br /> The responsible authoriry shaIl eomply immediataty,if passible,wich any requat aude pursuant to this subdivision,or wichin five days of <br /> the dac:of ctce reqaesc.ezciuding Sacurdays.Sundays and lcgal hoiidays,iF immedia�e compliance is not possibie. If he canaot compiy wich the requesc <br /> wichin�hac arne,he shalt so inform che individual,and may have an addidonal five days within which to comply wich the request,exciuding Sacurdays, <br /> Sundays and 1t3aI holidays. . , <br /> Subd.4. Froeedure when data Ls not accurata or complete. An icdividual may eont�st the accurdry or eompleceness oFpublic or pri��ace <br /> dam eonceming tiim.self. To exercise this right,an individual shali naafy in wridng the tespoasibie au�horiry dacn'bing the aature of che disagreemeac <br /> The respocuible auchoriry shalt wichin 30 days eict;er. (a)correct eha data fonnd to be inaccurac�ac incompiet-and aaempt to nodfy past recipiena of <br /> inaccurate or ineomplece data, including recipien�narTsed by cbe individua.l;or @)noafy the individual tfiat he believes the dati to be correec. Dati <br /> in dispa�e shall be disclosed only if the individuai's statemtnc of disagrcem:nt is included wi�h we d'uclosed dara. <br /> The dacertrunaaon o!the responsibla auchoriry may bc appaaled pursuanc to the provisiorts of che adminisaarive procedure act reladng to <br /> eontesmd cases. . • <br /> DATA PRIVACY ADYISORY � <br /> In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjeca of data",we wouId like to inform you that your request <br /> for a permit or license from the Cicy of Orono or any of its deparcments may require you to furnish certain private or <br /> confidential information. <br /> You are notified thar. <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 suppiy data, but refusal may require that the Ciry deny the permit or license. � <br /> 3. The information may be shased wich other local,state or federal a�encies to the extent necessary to process <br /> the permit or license. � <br /> 4. If your requested permic or license requires Council action to approve� some information may become <br /> . public, . _ . . . . . . . <br /> �5. You have certain ri�hts under NI.S. 13.04�(available upon request) to review privace data onyouurself. . <br /> 6. Your full name is requ;�ed to process this application or permit. <br /> , . ti; ` <br /> �', �%v�� 6�,�^v'� Ii�P;G�,�1,u <br /> Fust `��� T � �• ��'ddle ,. I.asc - <br /> !,�E' ^ f i � \ t � � �, <br /> Address� �r�i4��`i��1, '�.t�j � _ � <br /> �� �� �,\ !1'+4� ��.i�,; `''��1��� ; i:( �I l 1� . <br /> Ci�Y Sate Zip ` P�ane <br /> I understand my ri�ts as scated abov�. !; <br /> �. <br /> , , . <br /> .E;�l`�4'`Y'��� ' !u V�;V�Yit��,; <br /> Signature <br /> t <br /> •.J <br />