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� • Y . <br /> Sec.13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. The rights of individuai on whom the data is stored or to be stored shall be as set forth in this section. <br /> SuUd.2. Information required to be given individual.An individual asked to supply private or contidential data conceming himself shall be <br /> informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to suppiy invesNgative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. <br /> The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or prooertv tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be infonned whether he is the subject of <br /> stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of <br /> stored private or publ ic data on individuals shal I be sho�vn the data without any charge to him and,if he desires,shall be informed of the content and <br /> meaning of diat data. After an individual has been shown the private data and infonned of i[s meaning,the data need not be disclosed to him for six <br /> months thereafter uniess a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> 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 person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible au[hority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within Yive days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannotcomply�vith the request <br /> within that time,he shall so inform the individual,and may have an additional tive days within which to comply with the request,excl uding 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 data <br /> concerning himself To exercise this right,an individual shall notity in writing the responsible authority describing the nature ofthe disagreement. The <br /> responsible aufhority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in <br /> dispute shall be disclosed only ifthe individual's statement ofdisagreement is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 fike to inform you that your request <br /> for a perniit 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 inforn�ation you furnish will be used to determine your qualification for the permit or license <br /> 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 a�encies to the extent necessary to <br /> process 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 M.S. ]3.04(available upon request)to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. � <br /> C.t � ��_n�^ y -L"�.,,`, `r� �/�rY �� '��~ �� <br /> First Ntiddle Lxst <br /> y"� 7� � ' <br /> 7' <br /> Address � <br /> .. . t ,.�v... '�1,�. � . :/ 3�� -r j � �'� �� :�, ,.�. <br /> Cit�• State Zip Phone <br /> I understand my rights as stated aheve. <br /> l _ _ ��, <br /> Signaturc <br /> �� <br />