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• a' - Sec.13.04 RIGFiTS OF SLTB.IEGTS OF DATA ' Subd. 1. Type o[data. ?he righcs of individual oc whom the daa is stoced or m be scnced shall be u sec[occh in this secaon. Subd.2. Iaformaaon reqirired to be pven indi,ddual. An iadividual uYed w suppty pcivate or confidendal dard concerning himself shall be iatormed of: (a)�he purpose and in�ended use of the rcquesied dara wichia the colIecdng Stace agecry,polidcai subdivision,or smmwide rysum; (b)whe�er he mzy reEuse oY is.legally requir.d ro supply the cequesud data:(cj any larown coasequeaee uising ftom his supplyiug or refusing to supply ptivac:or conndeneal data;and(d)the ideadry of ocher persons or earides auchorized by st�ce or federal law to rnceive the dara. This requicemenc shall noc app[y when an individuaI is uked to supply invesdgadve daa,pucsuant ro secdoa 13.82,subdivision S,oo a law enfoccemeat officer. . 'Iha eecamissioner of rcvenue mav otac- che nodc� r�uired und-r this subdivision in the individua! income taz or orooem tax tefund insnucaans insuad of on those forms. Subd.3. Aceas to data by Individual. Upon requesc to a responsible authocity,an iadividual shall be infocraed whethec he is che subjecc of stor:d dac�on individuals,aad whecher it is c[assified u public,privace or confidendal. Upoa his fucther cequesc,aa individual who is che subjecc of scoced privace or pubtic daa on individuals shall be showa�he da�a wirhout any charge�him and;if he desires,shall be informed of the contenc and meaning of that dara. Afte�an individual has been showa the private dan and infaraud of ics meaaing,the daa need not be disclosed to him for siz moadss theceafter unleu a dispute o�acaon pursuanc w �his secdon is pending oc addidoeal da�a on the individual has beea colleued or created. Ihe responsibte auchoriry shall provide eopies of�he privare or pubtic daa upon request by rhe iadividual subject of che dara. The tesponsible auchoriry may require che cequesdng person to pay the accual coscs of makiag,cercifying,and compiling the copia. The cesponsible authoriry shaI(comply immediatety,if possible,wich aay requac made purntant w this subdivision,or wichin five days of the dace of che requesc,ezcluding Saturdays,Sandays and legal hotidays,if imenediace comptiaace is noc possible. If he cannot comply wi�h the requesc wichin that dme,he shall so inform the individual,and may have an addidonal five days wi@iin which m comply with the«quest,ezcluding Saturdays, Sandays and legal holidays. • Subd.4. Procedure whea data ts not aecurate or eomplete. An iadividual may concest the accuracy or completeness of public oc private dan conceming himself. To ezercise chis right,an individuaI shal!aoafy ia wridng die respoasible aufioriry descn'bing�he natuce of che disagreemeac The nspoeuible auehoriry shall within 30 days either. (a)cocnct[he da�a found co be inaccucate or incomplece aad atumpc to nodfy past recipiencs of iaaceunce or incomp[ece data.inciuding recipiencs named by the individual;or(b)nodfy the individual thac he believes the data m be correcc Data ia dispute shall be disclosed only il the individual's stacemenc of disagreement is included wirh the d'uclosed daa. The determination of the responsibte auchoriry may be appealed pucsuant to the provisions of the adminiscarive procedure act relaang to concemd 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 ia depactments may require you to furnish certain private or confidencial information. You aze notified that: 1. The information you furnish will be used to decermine your qualificadon 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 wich ocher local�sta[e or federal agencies to the extent necessary to process the permit or license. � 4. If your requested permit or license requires Couacil action to approve, some information may become public. 5. You have certai.n rights under M.S. 13.04 (availabie upon request) to review private data on.yourself. 6. Your full name is required to process this application or permi[. �'rs�' N�t`J►��,f lX�� o� -{�2.- (��e..l' Fint / 1�tiddle Lasc oZ�� s�aoLywdoo� Addcess � ' /�� Lf7�-Ol/I � Ciry Sa�e Zip Ph ne I unde�stand my rights as stated above. Signaare