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. <br /> Sec.13.04 RIGH'TS OF SUSJECTS OF DATA ' <br /> Subd. 1. Type of data. '!he righcs of individual on whom rhe dara is swced or ro be swcsd shall be u set focch ia�his secaon. <br /> Subd.2. Iatormaaon nquired to be�ivm tadividual. An iadividual ufced w supply private or confidendal daa concerning himself sha11 <br /> be info�ased of: (a)the purpou a�inteaded use of the tequested dan wirhia the collecang�tate agenry.poGdcal subdivision,or statewide rystem; <br /> (b)whether he tssay retuse ot is.kgatly required to supply the requesud data:(c)any Irnown coauquedce uising from his supptying or refiuing to supply <br /> privace or coafidendal data;and(d)the ideacry of ocher persons o�enrides authorized by sta�e oc fedenl law to receive the data. This requinmenc shall <br /> no[apply when an individual is uked to supply invescgarive dan,puesuant�secdoa 13.82.subdivisioa S,m a taw enfoc�ement officer. <br /> The coc�missioner of rcvenue mav olac- che nodc� rauirod under diis subdivision in the individual income ax or orooem tax relund <br /> instrucaons inscead of on chose fotms. <br /> Subd.3. Access to data bp individual. Upon nquesc to a responsible auchoriry,an individuat shall be informcd whethec he is the subjecc <br /> of smred daca on individuals,and whecher it is class�ed u public,private or confidendai. (lpoa his ti�rrher requesc,aa iadividual who is the subjecc <br /> of scored private or public daa on iadividuals shall be shown che data wichout any charge to him and;if he desires,shall be informed of the contenc <br /> and meaning of chu data. Afur an individual has been shown rhe private data and informed of iu meaning,the dan need not be disclosed oo him for <br /> six mondu theceatur unless a d'�spute or acdon pursuanc to chis secdon is pending or addirional da�a on the individual has been collecced or creared. <br /> The«spansible authoriry shall provide copies of the private oc public data upon nquest by the individuai subjecc o[rhe dua. The responsible authoriry <br /> may tequi�s che requesdng pecson to pay�he accual coscs of making,certifying,and compiling the copia. � <br /> The cesponsible auehoriry shall comply immedia[ely,if possible,wich any tequest made pursuant co this subdivision,or within five days of <br /> the date of the requesc,excluding Santcdays,Sundays and legal holidays,if immediate compliance is noc possible. If he canaoc comply with the requesc <br /> wiehin chat dme,he shall so infocm the individual,and may have an addidooal five days within which to comply wich the«quest,eacluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Ptoeedure when data ts not aceurate or camplete. M iadividual may contest the accuracy or completeness of pubtic or private <br /> dara conceming himsetf. To exercise this righ4 an individual shail nadfy in wridng rhe cespomible audtority describiag the nature ol the disagreemenc <br /> The responsible aufioriry shall withia 30 days either. (a)correcc the data found w be inaccunte or incomplea and atumpc to aodfy past mipientt of <br /> inaccurace or incomptece daa,including recipieacs named by ehe individual:or(b)nodfy the iadividual thac he betieves�he daca m be correcc Da[a <br /> in dispute shall be disclosed only iP the individual's statemenc of d'uagreement is included with the d'uclosed dan. <br /> The decerminadon of the rasponsible au�horiry may be appealed puauane to the pcovisions of the adminisaaave procedure act mlating to <br /> contesud cases. • <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04,Subd.2, "Righcs of subjects of data",we would like to inform you that your request <br /> for a permit or license from the Ciry of Orono or any of ics departments may require you to furnish certain private or <br /> confidential infonnation. <br /> You are notified that: <br /> 1. The informacioa 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 raay be shared with other local.state or federal agencies to the exceat 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 /> S. You have certain rights under M.S. 13.04 (available upon request) to review private data on younelf. <br /> 6. Your full name is required to process this application or permit. 7 <br /> � 1 ��"'��I���,,�G//`'�y <br /> � �� ��Q <br /> Fust Middle �� <br /> a�>»- ���.� ,���� � <br /> Address��� �� � �,� ��3� ,.�-���y�� <br /> Ciry Sace Zip Phone <br /> I understand my rights as stated above. <br /> Signaare <br />