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. � <br /> Sec.13.04 121GHTS OF SUBJECTS OF DATA <br /> Subd.l. Type of data. Thc rights of individual on whom the data is stored or to be stored shali be as set forth in this section. <br /> Subd.2. Intormation required to be given individuaL An individual asked to supply private or conFdential data concerning 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 Iegally 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 authoriud by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a la�v enforcement of(icer. <br /> The commissioner of revenue mav alace the notice required under this subdivision in the individual incomc taa or propertV tax refund <br /> instructions instead of on those fonns. <br /> Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be informed whether he is the subject of <br /> sfored data on individuals,and�vhether it is classified as public,private or confdential. Upon his further request,an individual wlio is the subject oC <br /> stored private or public data on individuals shall be sho�vn the data without any chaige to him and,if he desires,shall be in(ormed of the wntcnt and <br /> mcaning of that data. Aftcr an individual has been shown the privatc data and informed of its mcaning,the data necd not be disclosed to him for six <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible autl�ority may <br /> requice the requesting person to pay the actual costs of maldng,certifying,and compiling tlie copies. <br /> Thc responsiblc authority shall comply immediately,if possible,with any requcst made pursuant to this subdivision,or within fivc days o[the <br /> date of the request,excluding Saturdays,Sundays and Iegal holidays,if immcdiatc compliance is not possiblc. If hc cannot comply with thc requcst within <br /> that time,hc shall so inform the individual,and may havc an additional[ivc days within which to comply with the requcst,excluding Saturdays,Sundays <br /> 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 himsclf. To exercise this right,an individual shall notify in writing tlie responsible authority describing the nature of the disagreement. The <br /> responsible authority shall witliin 30 days cithei: (a)wrrcct the data found to bc inaccurate or incompletc and attempt to notify past recipicnts of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)noti(y the individual that he belicves the data to be correct. Data in <br /> dispute shall bc discloscd only if the individual's statement of disagreement 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�vould like to inform you that your request <br /> f'or a permit or licer�se from the City of Orono or any of its departments may require you to furnish certain private or <br /> cont"idential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualitication for the permit or license requested. <br /> 2. You may refuse to supply data,but refusal may require that tlie City deny the permit or license. <br /> 3. The inforn�ation may be shared with other local,state or federal agencies to the extent 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 /> 5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> ��I� r i c 1�'_' �� ,� , '�- �� <br /> First Middlc Last <br /> C�S- � S— S� S �t��_Y, %J �:�ta- L� . /,��"; <br /> Address <br /> � <br /> �'L� � �, ,����.-��, , 5 ����� i�% �s(, c_� i�s�-.�� - �/7� 6s� � <br /> City State Zip Phone <br /> I nderstand my rights stated above. <br /> Signature <br /> � <br />