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.� . . . � Sec.13.Q4 RIGKTS OF StT$JECTS OF DATa - - • Sabd. i. Typ-o[data. T�e righcs of individual on whom[he dara is scoRd or ro be smr.d sbalI be u sec forch in this secrion. Sutd.2. Iatormation reqtrirrd to be given iadiridual. ?n individual asked W supply privac.ar eoafidendal daca eoncerning hiaueTf sha?1 be in,°or¢::d of: (a)the parpose acd imm�ded use of che rcquest�3 daca withia[he eollecdn3 St�t�agenc.y.poliacal sutdivision,or samwide rystm• :(b)whec�e:ho:..ay r.hcsc or is.legally requir_d to suPP1Y.che r_quesud dsta:(cJ a:y Iaiowa eaas:queece arisiag frnm his si:ppiying or refusiag w suppty , pcivue oc eo:i::der.caI da�;ar:d(d)t�e ideadry af o�erFenoas orecddes ae�Wocized by su�.�or fcae_'!e:;:a r_:eive tae d3�. Zhis rquirc�eat s�� not a�piy w;.ea an i,:dividuaI is asked co suppIy iavesdgarive data,pucsuant to secdan 13.82,sut,+division 5,w a Iaw enfoccemeat o�cer. . • 'C�e eenmis5ionec of revenue mav olac- the noac- rauird und-r chis subdivisian in the individual income caz or oroaem t�z teEuad inscrucaons msuad of an those focros. . Sutd.3. Aecess to data by indiridual. Upon request to a responsibte auchoriry,an individual sball be inforzned wht�her he is che subjeu of stor_d dia an individuaLs,aad whe�her i[is elassified u public,private oc eonF.denaal. Upan his furcher r_ques�,aa icdividuaI wha is the subje:� a!stor.d priva:e ar public daa on individuaIs shall b�shown the dac�wi�haut iny charge to him and;if he desires,sha11 be informed of che eoacenc ar.d m:aning of chat data. Ahe�an individual has been shown the priva�.dae ar.d informed of irs meaaiag,the daca necd not be disclosed to him for siz monchs eher_afur unless a dispute or aeaon pursuant to ehis se:aon is pending oc addidoaal da�on the individaal has been eallec`d or erea4d. The respansible authoriry shall�provide eopies of the pcivac:or public daca uFon request by the iadividual subjcct oC che daa. Tha tespocuibie auchoriry may requir_ �Fce r.qu:sdng person to pay the accual eosts of makinz,earifying,ud comp'ding the eopia. The resgansibie auchoriry shall eompty immediatety,if possibie,wich aay reqaat made pursuanc co this subdivision.ac wichin flve days oE the dace o(the requese,excIuding Santcdays,Sundays and legal hotidays,if immediate compliaace is not possible. If he eannot compiy with tfio request within that dme,he shall so inform ehe individuaI,and may have an addiaoaaI five days wichin which ro campty wich the request,exciuding Satucdays, Sundays and Ie3aI holidays. . . Subd.4. Proeedure when data is not accurate or eomplete. An icdividual may eont�st the accurdcy ac eompieteness ofpabiic orpri�•ace daca concerning ti�msetf. To ezetcise this right,an individual shaIl aadfy in wridn�die«spoa.s�le auchoriry dosedbing the nanire oFthe disagreemeac. . The tesporesible authoriry shall wichin 30 days eick:cr: (a)eocrecc che data Caund to be inaccurat�or incompiece and ata:mpt to nodfy past recipiencs of inaccurate or incample�e data,including rccipieacs named by che individu�t;ar(b)aodfy che individual thac he believes the data to be correcc Daa in dispu�e shall be disclosed onIy if the individaal's scatemenc o!disagreem:nt is included wi�h the d'uclosed dara. . The de�:rminaaon of ehe rasponsible authoriry may be appealed pursuant to the provisions of tha adminisQadve pro<;dus act relating to eonter•r.d cases. � . - DATA PRIVACY ADYISORY In accordance with M.S. 13.04,Subd.2, "Rights of subjeccs of data"�we would like to inform you that your request for a permic or license from the City of Orono or any of ia departments may require you to furnish certain private or confidential information. You aze 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 supply data, but refusal may require that the Ciry deny the permit or license. � 3. The information tnay be shazed with ocher local,state or federal agencies to the eYtent necessary to process the permit or license. � 4. If your requested permit or license requires Council action to approve, some information may become . public, . . . . . . . . �S. You have certain ri�hts under M.S. 13.04�(ava.ilabte upon request) to review private data onyouurself. . _ 6. Your full name is required to process this application or permit. � ,� l' l�l��;l T ��G,��ti�G` Fitsc / .�.y �fid e Iasc - l��'D.-f-� ��1� �-�� Address /� � _ / /� Gt/G�'�f`L— LL�- �' `' -'`� 1 -/ �/ -G'� �—I Ciry Sace Zip P�one I understand my ri;hts as stated a ve. , �l:G`L � , L'�\ Signscure