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� Sec.13.04 RIGHTS OF SLfBJECTS OF DATa Subd. 1. Type of daca. The riehcs of individual on whom[he data is stored or to b�scored shall be as set fonh in this secrioo. Subd.2. Informalion reqirired to be given individual. An individual asked to supply privare or confideadal dara coacerning himself shall be informed of: (a) the purpose and in[ended use of the reques�ed daea within che collecdng"stat�ageacy, polidcal subdivisioa,or srarewide system; (b)whe[her he may refuse or is legally required to supply the requested data;(c)any Irnown coasequence arising from his supplying or refusing to supply • privace or confidenrial data;and(d)the idenary of ocher persoas or enanes authorized by stace or federal law to receive the data. This requiremenc shall no[apply when an individual is asked to suoply invesdgadve dara, pursuan�to secoon 13.82, subdivision 5, to a law enforcemen�ofFicer. The commissioner of revenua mav lace the noace reauired under this subdivision in the individual income tax or orooer[v tax refund insrrucdons insczad of on chose forms. Subd. 3. Access to data by indi�idual. lipon requesc to a responsible au�horiry,an individual shall be informed whe[her he is the subjecc of scored dara on individuals,and whecher i�is classified as public, priva�e or confidenrial. Upon his fur[her request,an individual who is the subjecc of stored private or public daca on individuals shall be shown�he data wichouc any charge to him and,-if he desires, shall be informed of che contenc and meaning of chat data. After an individual has been shown the priva[e data and informed of iu meaning, the data need no[be disclosed to hun for six mon�hs chereafter unless a dispute or acdon pursuanc to this secrion is pznding or addiaonal da�a on the individual has been coflecu.d or created. The cesponsible auchoriry shalt provide copies of the private or public data upon requese by the individual subjecc of�he data. The responsib(e authoriry may require �he requesring person to pay the accual coscs of making,cerafying, and compiling the copies. The responsible au�horiry shall comply immediacely,if possibl�, with any request made pursuant to chis subdivision, or wirhin five days oF the da[e of che requesc,excluding Sacurdays.Sundays and legal holidays,if immediace compliance is noc possible. If he canno[comply wich the reques� wi[hin cha�cime,he shall so inform�he individual,and may have an addidonal five days wirhin which co comply wi�h the request,excluding Saturdays, Sundays and legai holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness oF public or pri�•ate data concerning himself. To exercise this riehc,an individual shall nodty in wriang the responsible authoriry describing the nature of the disagreement. The responsible auchoriry shall within 30 days either: (a)correce the da�a found to be inaccurdte or incomplece and attempc to nodfy pasc recipienu of inaccurdte or incomplete data, including recipienes named by rhe individual; or(b)nocify the individual that he believes che data to be cocrect. Data in dispute shall be disclosed only if the individual's stacement of disagreemenc is included with[he disclosed data. The determinarion of the responsibte authoriry may be appeatzd pursuant co the provisions of the admiruscradve procedure act relaang to contes[ed 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 permi[ or license from the Ciry of Orono or any of its departments may require you to furnish certain priva[e or confidential information. You are 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 da[a, but refusal may require that the City deny the perm.it or license. 3. The informa[ion may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested pernu[ or license requires Council ac[ion to approve, some informa[ion may become public. j. You have certain riQhts under M.S. 13.04 (available upon reques[) to review private data on yourself. (. Your full name is required co process this application or permit. �\� . - ��;�� .� ll��e� Fi� �tiddle Last �{ �,� S �o r�� ` L-/� j� t,. Address r ��u.c-�Cl� �'�/�`v ��NLI � G � �� Ciry Srate Zip Phone �' � I under�tand my ri;hts stated above. i � �_ �' � 5ignature