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See.13.04 RIGHTS OF SUBJECTS OF DATA Subd.I. Type of data. The rights of individual on whom the data is stored or to be sWred shall be as set forth in this section. Subd.2. Infortnation requirod W be givp�individuel.An individual asked to supply private ot confidendal data conceming himself slmll be informed of: (s)the purpose and inunded use of the requested dam within the collxting sbte agency>political subdivision,or stetewide systwn;(b) wlxtha he may refuse or is legally required to supPlY the roquesoed data;(c)arry known consequence arising from his supptying or rcfusirtg to suPP�Y private or confidentiel data;and(d)d�e identity of other persona or entities authoriud by state or federat law to receive the data.This ra�uiremrnt shel l not apply when an individual is askod to supply investigative data,pursuant W section 13.82,subdivision 5,to a law enforcemem officer. The cortunissioner of revenue mxv plece the notice reauired under this subdivision in the individual income tax or pro tax rofund inswctions instead of on those forms. Subd.3. Acc�s to data by individual. Upon roquest to a responsible authority,an individuel shap be infortned whetlur he is the subject of stored deta on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is d�e subject of storcd private or public data on individuals shall be shown the data without any etarge to him end,if he desircs,shall be informed ofthe content and meaning of that data After an individual has been shown du private data and infocmed of its meaning,the data rxed not be disclosed to him for six months thereafter unless a dispuu or action pursuant W this section is pending or additional data on the individual has been collected or created. The responcible authority st�all provide copies of the private or public data upon req�st by the individual subject of the data The responsible suthority may requirc the requesting pe�son to pay the acwel co�s of making,certifying,and compiling Uu copies. 'Ihe responsible authority shaU comply immedietely,if possible,with any request made pursuant w this subdivision,or within frve days of the date of du request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibla If he cancrot canply with the request within that time,he shall so inform the i�ividual,and may have an addidonal five days within which to comply with the request,excluding Satundays, Sw�days and legal holidays. Subd.4.Procedure when data is rrot accurau or complete.An individusl may coMest the accucacy a completeness of public or private data conceming himsel£To exercise this right,an individual shal I notify in writing the rcsponsible authority describing the nature ofthe disagreement.'i7ie responsible authority shall within 30 days either: (a)wcrect the data found to be ineccurau or incompleu and attempt W notify past recipieMs of ineccurate or incomplek data,including recipients named by dx individual;or(b)notify the individual that he believes the data W be comect.Data in dispute shell be disclosed only if the individual's statetnent of disagrament is included with the disclosed data. 71u determination of the responsible authority may be appeeled pursuant to the provisions of Uu administrative procedure act rolating W conusted caves. DATA PRIVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we woutd like to inform you that yow request for a permit 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 qualificaiion 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 yors requested pennir or�icense requires Council actton to a�prove,some informatiorr rrlay 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. Y'c�. :c.�..z�r 1 �,�-- Firot Middk I.ast \ �(a 0 `�Lle r� I,`.� � � Addreu � �,�►.,1 a�.�-►4r�4- n�� 5S� 9 r 9S Z-�8 6-��o y City State Zip P6one I�a�lerstsad ruy ri s sta bov� Sigoature i „�� n�;�i I pl�tu , 32