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� . � Sec.13.0-1 RIGHTS OF SUBJECTS OF D�Ta Subd. 1. Type of data. '!he righa of individual on whom�e dara is s�rr1 or co be scored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An indi�idual asktd w supply privare or confidendal data conce�ning himself shall be informed of: (a)[he purpose and ineended use of the requesud dara w:�in the collecang Y[ate agency,polirical subdivision,or sratewide syscem; (b)whuher he may refuse oY is legally rcquired co supply[he requested daa:(c)any 1�owa eoasequence arising from his supplying or refusing to suppiy private or eonridendal data;and(d)the idendry of other peaoas or eaddes xachoriz;d by srate or federal law to receive the daca.,This requ'uemen[s6a11 not apply when an individual is asked to suppiy invesagarive data,pursu�:[co secdoa 13.82,subdivision 5,co a_law enforcement o�cer. The commissioner of roeenue mav place the norice rewired�rd-r this subdivision in the individual income tax or proaem tax refund instructions insccad of on chose forms. Subd.3. Access to data by indi�idual. Upon requesc to a r.spoasible auchority,an individual shall be informed whether he is che subject of scored data on individuals,and whether it is classified as public,privar�or confidecrial. Upon his furcher request,an individual who is the subject of storni priva[e ot public dara on individ'uals shall be shown che dara wiu ou�any c'n>;e to him and;if he desires, shall be informed of the coacenc and meaning of chat data. Aher an indiiidual has been shown ehe privam�aa and i�:ormed of ics meaning.[he data need not be disclosed to tiun fo� six monchs ehereaiter unless a dispute ar acdon pursuant to chis secdon is�:nding or addiaonal daca on the individual has been collected or creaced. 'Ihe responsibte auchoriry shall provide copies of che privace or public dac�c�on requ:s:by[he individual subjecc of the data. The responsible auchoriry may require[he requesang person to pay the actual cosu of making,cer;•ing,ar.d compiling the copies. The responsible auchoriry shall comply immedia�aly,if possibk,wi�h any r:quest made pursuant to this subdivision,or wiehin five days of the date of che requesc,excluding Saturdays,Sundays and tegal holidays,ii ir,.mediace eompliance is not possible. If he cannot comply with the request wichin[hac time,he shali so inform the individual,and may have an addice;.al five days wi[hin which to comply with�he request,ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data Ls not accurste or complete. An indivi�ual may contest the accuracy or completeness of pubtic or private daca conceming himself. To exercise�his rieht,an individual shall nodfy ia wriang te respoasible authoriry describing che nacure of the disagreemeac. The responsible aufioriry shall within 30 days either: (a)correct che dae tcund to be inaccurate or incomplete and attempc to nodfy pasc recipiencs of inaccurate or incomplete data,including recipients named by the individLl:or(b)codfy the individual that he believes rhe data to be correcG Data in dispuce shall be disclosed only if[he individual's statemenc of disagr:e�en�is i.c:ndad with che disclosed dara. The decerminarion of the rasponsible authoriry may be appea:ed pursuac�to the provisions of eho adminisaarive procedure act reladng to contested cases. . � . ' DATA PRIV�,CY AD�'ISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects oi data",we would like to inform you tha[your reouest for a permic or license from the Ciry of Orono or any of i� depa.rmznts may require you to fumish eertain privace or confidential information. You are notified that: 1, The information you fumish will be used to de:ermine�-our qualification for the permit or license requested. 2. You may refuse to supply data, buc refusal nay require that the City deny the permit or license. 3, The information may be shared with ocher loc�l, state or federal a�encies to the excent necessary to process the permit or license. 4. If your requested perm.it or license requires Council action to approve, some information may become . . public. . �, You have certain rights under M.S. 13.04 (a�ailable upon request) to review private iiata on yourself. (, Your full name is required to process this aoplica�ion or permic. � 'L . ��'h 1 � Firsc .�- biid Last �1�0� ,� x c� s�� Address �� J�—�L,f�(� ��"'j�^ U�3_- O 'C�Llb S� 2.c�v,'S �, � � Y�n Ciry Sta�e Zip Phone I underst my ri s ated above. , � � �- 2- � I signacure