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, ) Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The rights oF individual on whom the data is stored or to be stored shall be as set foRh in this section. Subd.2. Information required to be given individual.An individual asked to supply private or confide�tial data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall no[apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue ma�place the notice required under this subdivision in the individual income tax or vrooertv tax refund instivctions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be infortned of the content and meaning of that data. ASer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or actio�pursuant to this section is pending or additional data on the individual has been coilected 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 authoiity may require the requesting person to pay the actual costs of making,ceRifying,and compiling the copies. The responsible authoriry shall comply immediately,ifpossible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. !f he cannot comply with the request within that time,he shall so infortn the individual,and may have an additional ftve days within 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 wntest the accuracy or completeness of public or private data concerning himsel£To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The rosponsible authority shall within 30 days either: (a)coRect the data found to be inaccurate or incomplete and attempt to notify past rocipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be coirect.Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detern�ination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested 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 pennit 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: l. 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 pemlit 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 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. �Am�S ��- J � � �.e �e �� First Middle Last �`� � S S�v��- �rQ ��,� ✓� Address r� r��,�� `v. �s 3�i 9s�- ��sy- �%> Citv State Zip Phone I understand my rights as stated above. , � �ti� � , Si ature 32