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_ �'' , r Sec.13.04 RIGF3TS OF SUBJECTS OF D�TA Subd. 1. Type of data. The righcs of individual oa whom the dara is scored or to be stored shall be�s set forth in chis secaon. Subd.2. Information reqwred to be given individual. An individual asYed to supply private or confrdendal dara conceraing himself sfiall be informed of: (a)the purpose and inteaded use of the tequest�d dara wirhin the collecaag state a,enty,poiiacal subdivision,or smtewide rystem; (b)whecher he may refuse oY is legally cequir�d�o supply che requested daca;(c)any known coasequeace arising from his supplying or refusing W sapply ' private or conndendal data;and(d)che idendry of ather persoas or endries authorized by stace or federdl law to receive the daca. This requirement shall not apply when an individual is asked to supply invesrigarive dan, pursuant to secdon 13.82,subdivision S, to a law enforcemenc officer. 'Ihe commissioner of revenue mav place the nodce reouired under this subdivision in the individual income raz or orooem �z refund instrucdons iastead of on[hose forms. Subd. 3. Access to data by individual, Upon requut to a responsible authoriry,an individual shall be informed whether he is tfie subject " of scored data on individuals,and whecher ic is class�ed as public,private or confidendal. Upon his further request,an individual who is the subjecc of storcd private or public dara on individvals shall be shown the dara wi�hout any charge to him and,-if he desires, shall be infocmed of the eontent and meaning of that data. Afte�an individual has been shown tbe private data and informed of iu meaning,tbe dara need not be disclosed ro him for six monchs thereaher unless a dispute or acdon pursuanc to rhis secdon is pending or addidonal dan on the individual 6as been collecc�d or creat�d. The responsible au[horiry shall provide copies of the private or public dard upon request by the individual subject of the dara. The respoosible autfioriry may require the requesdng person to pay tho accual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, wi�h any request made pursuant to this subdivision,or wichin five days of the dace of the zequest,excluding Saturdays,Sundays aad legal holidays,if immediate compliaace is noc possible. Lf he cannot comply wich the request within[hac ame,he shall so inform the individual,and may havo an addiaooal five days within�which co comply wich the request,exciuding SaAudays, Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or private data concorning hirnself. To exer�ise this right,an individual shall nodfy in wriang the respoasble auchoriry describing the nature of the disagreemeat The responsib(e authoriry shall within 30 days ei[her: (a)correct the data found to be inaccurdte or incomplece and attempt to nodfy past mipieats of inaccurdte or incomplete dara, including recipients named by the individual;or(b)notify the individual that he believes tbe data to be correct Data in dispute shall bo disclosed only if[he individual's s�temenc of disagreemenc is inciuded with[he d'uclosed dara. The determinarion of[he responsible authoriry may be appealed pursuant to the provisions of che adminisaadve procedure act telaang to contesced eases. DATA PRIVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "Rig.hts of subjects of data", we would like to inform you that your request for a permit or license from the Ciry 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 permi[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 ocher local, state or federal agencies to the eztent necessary to process the permit or license. 4. Ir 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. F�C�iS�,� k�,�_ne� ` , First Middlc I,asc -'�4�� S�c,c-��r�Z �Y� �Ci Address , c_ (v0��i�� v�/U �S3`tZ_ `'1 7( � i�'� � . Ciry Sm[e Zip Phone I understand my ri�hts as stated above. �� st��r�