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1 <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DaT?. <br /> Subd. 1. Type of data. The rieh�s of individual on whom[he data is s�ored or to be scored shall be as se�forth in this secdoo. <br /> Subd.2. Infocmation reqirired to be given individual. �.n individual asked to supply privace or confidzndal dara coaceming himself shall <br /> be informed of: (a)the purpose aad intended use of the requested data within the collecdng'state ageocy, polirical suhdivision,or scatewide rystem; <br /> (b)whe[her he may refuse or is tegally required to supply the requested data;(c)any lmovm coasequence arising from his supplying or refusing to supply <br /> • private or conndenoal dara;ar.d(d)che idenriry of other persoas or enriaes aurhorized by s[ate or federal law to receive the data. "Ihis requirement shall <br /> noc apply when an individu�t is asked co suoply invesri�aave daca, pursuanc to secaon 13.82, subdivision 5, to a taw enforcemznt o�cer. - <br /> The commissioner of revenu- mav place the noac� r�ouir�d undAr [his subdivision in the individual income taz or prooem tax reEund <br /> inscrucaons inscead of on those forms. <br /> Subd. 3. Access to data by indi�-idual. Upon request to a responsible authority,an individual shall be informed whecher he is the subject <br /> of scored da�a on individuals,and wherher ic is classified as public, privace or confidenaal. Upon his further request,an individual who is the subject <br /> of scored privace or public dara 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[hat data. After an individual has been shown the private data and informed of ics meaning, the data need not be disclosed to him for <br /> six monrhs therea[ter unless a dispute or acaon pursuan[to [his secaon is p�nding or addiaonal data on the individual has been collecced or creatPd. <br /> The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subjecc of the data. The responsible authoriry <br /> may requice the requesring per5on to pay thz actual cos�s of makine, cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immedia[ely, if possible, with any request made pursuan[to this subdivision,or within five days of <br /> the dace of che requesc,excluding Sacurdays,Sundays and legal holidays,if immzdiate compliance is not possible. If he cannoc comply with the requesc <br /> within[hat time,he shali so inform the individual,and may have an addirional five days within which to compiy with the request,exctuding Saturdays, <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�his rieht,an individual shall noa"ry in wrian�the responsible authoriry dzscribing the nantre of the disagreement. <br /> The responsible authoriry shall wichin 30 days either: (a)correcc the data found to be inaccunte or incomple�e and attempc to nodfy pasc recipien�s of <br /> inaccurate or incomplete data, including recipien¢named by the individual; or(b)nocify the individual that he believes [he data to be correct. Data <br /> in dispute shall be disc(osed oniy if the individual's sta�ement of disagreement is included with che disclosed data. <br /> The dererminarion of ehe responsibte auchoriry may be appealed pursuanc to the provisions of the adminiscradve procedure act relating to <br /> contested cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Rishts of subjects of data", we would like to inform you that your request <br /> for a pernut 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 /> 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 permi[ or license. <br /> 3. The informa[ion may be shared wi[h other local, state or federal agencies to the extent necessary to process <br /> the pernut 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 fu11 name is required to process this application or permit. <br /> i�' GC���� <br /> _.__---�='�'-�Ul O ��r�'u c G <br /> First �fiddle � Last <br /> �biY �'��rs<� ��rrc � <br /> Address,� . <br /> �,r� \ ,,,,5 `,-'",7 `:`�,� y5_s�/' <br /> ��A'% � s � Y� �� <br /> Ciry . State Zip Ptione <br /> I understand my rights as stated above. <br /> ,_ <br /> --_____ � <br /> � <br /> � ���-����'�� 1 c --- <br /> 5ignamre <br />