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Sea 13.04 RIGHTS OF SIJB,TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given iadividual. An individual asked to supply private or confidendal dara concerning himself shall be informed of: (a)the purpose and in[ended use of the requesud dara within the collecang�tate agency,political subdivision,or statewide rysum; (b)whether he may refuse oY is legally required to supply the requesud dara:(c)any lasown coasequence arising from his supplying or refusing to supply � privace or confidendal data;and(d)the ideaury of o[her persons or enaaes authorized by state or fedecal law to receive the dara. This requ'uemenc shall aot apply when an individual is asked to svpply invesdgadve data,punuant to secdon 13.83,subdivision 5,to a law enforcemen[o�cer. - The commissioner of rovenue mav alace the nodce reauired under this subdivision in the individual income tax or vropertv taz refuad instrucdons instead of on chose forms. Subd.3. Access to data by individual. Upon request to a respansible authority,an individual shall be informed whether he is the subject af stored data on individuals,and wheeher it is ctass�ed as public,private or confidendal. Upon his further request,an individual who is the subjecc of stored private or pubtic dara on individuals shall be shown the daca wichouc any charge to him and;if he desires,shall be informed of the contenc and meaning of that daca. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed w him for six months thereafur unless a dispute or acaon pursuant to chis secdon is pending or addidonal data on the individual has been collected oc created. The responsible auehoriry shall provide copies of the private or public data upon request by rhe individual subject of the data. The responsible authority may require the requesring person to pay the actual coscs of making,certifying,and compiling the copies. The responsible authoriry shall compiy immedia[ely,if possibie,with any request made pursuant to this subdivision,or within five days of the date of the requesc,excluding Satu�days,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the roquesc within rhat time,he shall so inform che individual,and may have an addidonal five days wi[hin which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conust the accuracy or completeness of public or private dara conceming himself. To exercise�his right,an individual shall nodfy in writing the responsible suthoriry describing the nacure of the disagreement. The responsible authority shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and attempt to nodfy past recipientc of inaccurate or incomptece data, including recipiencs named by[he individual;or(b)nodfy the individual that he believes the data to be coaect. Data in dispute shali be disclosed only if the individual's statement of disagreemenc is included wi[h�he disclosed data. The determinadon of the responsible auchoriry may be appealed pursuanc to the provisions of the adminisaarive procedure act relating to contesud 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 furnish certain private or confidential information. You aze notified thar.� 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. The information may be shazed 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. Gd u.RA�D —!O FfN KELD First p� Middle �t 3$qQ �EIDREL(NE 1��2t✓E Address / G(�/�YT�f/� ( ��PDnlO, /�/�/� J`�5�3�l-�7e�.S� �lo/�- ''�7�g/Q l Ciry CM.��,u.�G� /JC�va.� Stace Z►p Phone I understand my rights as stated above. Sig re