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� . , , Sec.13.04 RIGHTS OF SUBJECTS OF D?,TA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be swred shall be as set forsh in this secdon. Subd.2. Information reqirired to be givea indiridual. An individual uked to supply privare or confidendal data concerning himself shall be informed of: (a)the purpose and incended use of the rzquesred daa wichia ehe collecang suce agency,polidcal subdivision,o�stacewide rysrem; (b)whecher he may refuse or is legally czquired to supply[he requesud da[a:(c)any]rnown coasequence arising from his supplying or refusing to supply privace or eonfidendal dara;and(d)the ideaary of o�her persoas or enddes auchorized by state or federal(aw to t�ceive che data. 7his requiremenc shali noc apply when an individual is asked to supply invesrigarive dara,pucsuanc to secdon 13.82,subdivision 5, to a!aw enforeement ofFcer. - The commissioner of revenue mav olace the noace r-auired under this subdivision in the individual income tax or orooertv taz cafund instrucaans instead of on chose forms. Subd.3. Access to data by individual. Upon requesc to a responsible aurhority,an individual shall be informed whether he is the subject of scored dac�on individuals,and whechac it is dassified as pubiic,privace or conFidenaal. Upon his fur�her request,an individual who is[he subject of scored privace or public daca on individuals shall be shown che dara wichout any charge to him and;if he desires, shall be informed of the content and meaning of chat data. Aher an individual has been shown the priva�e data and informed of ics meaaing,the dara need not be disclosed m him for siz monchs�hereafur uriless a dispute or acaon pursuanc to�his secdon is ponding or addidonal daca oa the individual has been collected or creared. The responsible authoriry shall provide copies of the priva[e or public data upon cequest by the individual subjecc of[he daca. The responsible auchoriry may require the requadng pecson to pay�he actual costs of making,cerdfying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to chis subdivision,or wichin five days of ! the dace of che request,excluding Sacurdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply with the requesc i within chac time,he shall so inform the individual,and may have an addidonat five days wi[hin which to comply wi[h the request,excluding Saturdays, , Sundays and lega!holidays. ' Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private dara concerning tiimself. To exercise chis right,an individual shatl noafy in wridng ehe responsibie aurt►oriry describing ehe nature of the disagreemenc. The responsible authoriry shall within 30 days eicher: (a)correct ehe data found to be inaccurate or incomplece and attempc to nodfy past recipients of inaccurate oc incomplece data, including recipienrs named by[he individual;or(b)notify the individual that he believes the data to be coaect Data in dispute shall be disclosed oniy if the individual's scacement of disagreement is includzd with che disclosed data. The de�erminadon of the responsible au�horiry may be appealed pursuant to the provisions of[he adminisaarive procedure act relaang to contested cases. DATA PRTVACY 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 Ciry of Orono or any of its departments may require you to furnish certain private or confidential information. You aze 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 perm.it or license. 3. The information may be shared with ocher local, state or federal a;encies to the ex[ent necessary to process j � 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 onyouurself. 6. Your full name is required to process this application or permic. �✓�/ �. i`'' �fiddle Lasc Firsc /�� Addl:;� � � �v � s� � City State Zip Phone I understand my stated above. � .� Signature