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Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The rig6ts of individual on w6om the data is stored or to be stored s6all be ss set torth in this section. Subd.2.Information required to be given individual.An individual asked to supply private or conTidenHal data concerning 6imself shall be informed of: (a)the purpose and intended use of t6e requested data wit6in the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising fram his supplying or refusing to supply private or coufidential data;and(d)the identity of other persons or enHties authorized by state or federal law to receive the dats.This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a lew enforcemeot oflicer. The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income tax or urouertv taa refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be in1'ormed whether he is t6e subject af stored data on individuals,and whether it is classified as pub►ic,private or confidential. Upon 6is further request,an individual who is the subject of stored privste or public data on individuals shall be s6own the data without any charge to him snd,if he desires,shall be informed of the content and meaning of thst dats. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him tor six mont6s thereafter unless a dispute or action pursuant to this secfion is pending or addiHonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by t6e individual subject of the data.The responsible authority may require the requesting person to pay the actual costs of making,certifying,aod compiling t6e copies. The responsible authority shall comply immediately,if possible,wit6 any request made pursuant to this subdivision,or within five days of the date of the request,eacluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply wit6 the request,excluding Saturdays,Sundays and legal holidsys. Subd.4.Procedure w6en data is not accurate or complete.An individual may contest the accuracy or completeness of public or private data concerniog himself.To exercise this right,an individual shnll notify in writing the responsible authority describing the nature of the disagreement.The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes t6e date to be correct.Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible eut6ority may be appealed pursuant to the provisions of t6e administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualitication for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other local,state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You 6ave certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. Mic�ael Robert Mischke First Middle Last 1972 Shad�wood Road Address Orono �� rz�� ( 612)270-8451 C�ty State Zip Phone I understand my rights as stated above. � �' 7? v-z3-�y Signature ��, tY��,��'"`�`�+�;;,: �.,�