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.'�. Sec.13.04 RIGHTS OF SUB.TECTS OF D:1T�1 Subd. 1. Type of data. The riehts of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information required to be given individual. An individual asked[o supply private or confidenrial data concerning himself shall be informed of: (a) the purpose aod intended use of the requested dara wichin the collecting"state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising from his supplying or refusing to suppty private or confiden[ial data;and(d)the iden[ity of other persons or entities au[horized by state or federal law to receive the data. This requirement sball not apply when an individual is asked ro supply invesdeadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instructions ins[ead of on chose forms. Subd. 3. Access to data by indi�idual. Upon requesc to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals, and whether it is classified as public, private or confidenoal. Upon his further request, an individual who is the subject of srored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of rhat data. Afrer an individual has been shown[he privace data and informed of its meaning,che data need not be disclosed to him for s;;;;;1;,;�?;s;};e:�a;;:::�,csucs; a��sp:::e�r'C'�.2P.r!1'Sll�C`!�n ;)1ic c_rCTIn�is rending or addi!ional data on che individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible au[horiry may require the requesting person to pay the actual costs of makine, 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 da[e of the request,excluding Saturdays,Sundays and leeal 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 with the request,excluding Sarurdays, Sundays and 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 rieht,an individuat shall noafy in wri[ing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of inaccurate or incomplete data, including recipients named by [he individual; or(b)notify the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's starement of disagreement is included with the disclosed data. The decerminarion of the responsible authoriry may be appealed pursuanc to the provisions of the administradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request for a permi[ 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 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, rjle IIITOiIT13ilOR L113y ve�i a��u'vviCu O.L�;.��W�, gr�rP nr far�Pral �oPT1!'7P.S IO tlle eXleIIt IleCeSS3ry IO�IOCeSS �j`-- the pemut 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. � �. � ,�.�� (�,�, � ��i - First Middle � Last �� . Address� _ J� Z u G � J" `J V �. � � �L, —(J �� l�� F> l C��, State Zip Phone � I understand my right stated above. �� Signa[ure