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� , _ � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in ttus section. Subd 2.Infotmation required to be given individual.An individual asked to supply private or confidential data concerning himself shall be informed oE (a)the purpose and intended use of the requested data within 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 la�own consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities suthorized by state or fedeial law to receive the data.Tlvs requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice reauired under this subdivision in the individual income tax or property tax refund instructions instead of on those forms. Subd.3.Access to data by individual.Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his furt6er request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,s6a11 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 disclosed to him for six monchs thereafter unless a dispute or action putsuant to this section is pending or additional data on the individual has been collected or created. The responsible suthority shall provide copies of the private or public data upon request by the individual subject of the data. T'he responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pucsuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and]egal holidays,if unmediate compliance is not possible.If he cannot comply with the request within t6at time,he shall so infonn the individual,and may have an additional five days within which to comply with the requesy excluding Saturdays, Sundays and legal holidays. Subd.4.Procedure when data is not accurate or complete.An individual may contest the accuracy or wmpleteness of public or private data conceming himself.To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disageement The responsible authority shall within 30 days either: (a)co�rect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incompletc data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The deternunation of the responsible suthority may be appealed pursuant to the provisions of the administrative procedurc 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 fumish certain private or confidential informarion. You are norified that: 1. The information you fumish will be used to determine your qualification 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 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. First Middle Last �J�}-�,v /��.��s �'�na� Address �n��/�- �1;��/ s�-a 3� ysL�� l�a� City State Zip Phone I understand rights as stated ab e. Signature .,'�p � q ��;y' R�' �1� �� ,.. 32