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• �;r Sec.13.04 RIGHTS OF SUBJECTS OF DATA � Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. R Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,poliacal subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The com�russioner of revenue mav olace the norice reouired under this subdivision in the individual income tax or nrocertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the dara without arry charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disolosed to him for six months thereafter unless a dispute or action pursuant ro this secrion is peciding or additionai data on the individual has been collected or�reated. The responsible authoriry shall provide copie's of the private or public data upon request by the individual subject of the data. The respohsible autt�oriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made.pursuant to this subdivision,or within five days 'of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that rime, he shall so inform the individual, and may have an addirional five days within which to comply with the request, excluding Saturdays,Sundays ar�d legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)conect the data found to be inaccurate or utcomplete ac�attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shalt be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administraave 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 Ciry 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 qualification for the permit or license requested. 2. You may refuse to supgly•data, but refusal may require that the City deny the permit or license. 3. � The information may be shared witli otlier 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 have 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. LiGrM.� �Go�"' J'r`:f',vI':�� First / Midc�e Last 2� Sy s I,�J„ �,.�oJ t�� Address !��-'��r rv�v�/ 5 ti 34/ y 71'�� �i�y State Zip Phone I understand my rights as stated above. �- Signamre 6