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Sec.13.04 RIGHTSOFSUBJECTSOFDATA <br /> Subdivision/. Type ojdata The rights ojrndividua!on whom the data is stored or to be stored shall be as set forth in thrs section. <br /> Subd.2. Injormation required to be given individuaC An individual asked to supply private or confidential dvta concernrng hrmself <br /> shall be injormed of.• (a)the purpose and intended use of the reguested data wrthin the collecting state agency,politrcal subdivrsion,or slatewide <br /> system;(b)whether he may refuse or is legally requrred to supply the requested data;(c)any known consequence arising from his supplying or <br /> refusing lo supply private or confidential data;and(d)the identrty of other persons or entities authorized by state orfederal lmv to receive the data. <br /> This requirement shall not apply when an indivrdual is asked to supply investigative data,pursuant to section 13.82, subdivision 5, to a!mv <br /> enforcement o�cer. <br /> The commissioner o/'revenue may place the notice required under this subdivision in the individual income tax or property tax refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Uponrequest to a responsible authority,an indivrdual shal!be informed whetherhe is the subject <br /> oJstored data on individuals,and whether it is classified as publrc,private or confidential. Upon his furlher request,an indivrdual ivho is the <br /> subject of stored private or public data on individuals shall be shown the data wrthou�any charge to hrm and,iJhe desires,shall be informed of <br /> the content and meaning of that data. After an indrvidual has been shoivn the prrvate data and injormed af its meaning, the data need not be <br /> disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additrona!data on the rndividual has <br /> been callected or created. The responsible authority shall provrde copres of the private or p:iblic data upon request by the indivrdual subject of <br /> the data. The responsible authority may require the requesting person to pay the actual costs of making,cert�ing,and compiling the copies. <br /> The responsible authorrry shall comply immediately,if possible,with any reqiiest made pursuant to this subdivisron,or within five days <br /> ojthe date of the request,excluding Saturdays,Sundays and legal holidays,if rmmediate compliance is not possrble. Ijhe cannot comply ivith the <br /> request within that time,he shall so inform the rndividual,and may have an additionalfive days tivithrn tivhich to comply with the request,excludrng <br /> Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete.An indivrdual may contest the accuracy or completeness ojp:�blrc or private <br /> data concerning himse f To exercrse thrs rrght, an individual shall notify in writing the responsible authoriry describrng the nature of the <br /> disagreement. The responsible autharrty shal!within 30 days either: (a)correct the data found to be inaccurate or incomp/ete and attempt to not� <br /> past reciprents of rnaccurate or incomplete data,rncludingrecipients named by the individual;or(b)not�the indrvidual that he believes the data <br /> to be correct. Data in dispute shall be disclosed only if the individual's statement of drsagreement is rncluded with the disclosed data. <br /> The determination ofthe responsible authoriry may be appealed pursuant to[he provisions ojthe admrnistrative procedure act relating <br /> lo contested cases. <br /> DATA PRIf�ACYADVISORY <br /> In accordance wrth M.S.13.04,Subd.2, "Rights ofsubjects oJdata';we would like to inform you thatyour requestfor a permit or license <br /> from the City of Orono or any of its departments may require you to furnish certain private or confrdential rnformation. <br /> You are notified that: <br /> 1. The informatron you furnrsh wil!be used to determine your qualifrcation for the permit or license requested. <br /> 2. You may refuse to supply data,but refusal may requrre that the Ciry deny the permit or license. <br /> 3. The information may be shared wrth other local,state or federal agencies to the extent necessary to process the permit or <br /> � license. <br /> 4. If your requested permit or license requires Council action to approve,some information may become public. <br /> 5. You have certain rights under M.S. 13.03(see jallowing page)to review private data on yourself. <br /> 6. Your full name rs required to process this application or permit. <br /> PLEASE PRINT <br /> :� :� <br /> �/J ►��� ,�t i`� `; ^� l., C-": 5 i`"t � t_iY, `{ .I� <br /> First Middle Last <br /> � 1 '3 (� � 1�1 r A �i � iv ' i1�� _ <br /> Address <br /> r �EC �r � �� �o � 1"�tv C � 3�3r C�t'�.��3 � 1 �'��1i'7 <br /> City Slate , Zip Phone <br /> 1 understand my rights as stated above. <br /> � ) � <br /> C� <br /> Signature <br /> /0 <br />