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. , e Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Z�pe of data. 'Ihe righcs of individual on whom the data is stoied or to be stored shall be as set forth in this secaon. Subd.2. Information required to be given individual. An individuai asked W supply private or confidendal data conceming himself shall . be informed of: (a)the purpose and intended use of the requutcd data withia the collecting State agency,polirical subdivision,or statewide sysum; (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 confidenaal data;and(d)the idendry of other persons or endtics authorized by m,u or federai law to receive the dara. This requ'uement shall not apply when an individual is asked to suppiy invesagauve dara,pursuant to secfian 13.82,subdivision 5,to a law enforcement officer. The eommissioner of revenue mav place the nooce required under this subdivision in the individual income tax or nropem tax refund inscrucdons msuad of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is class�ed 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 w him and, if he desires,shall be informed of the content and mcaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or action purs...uit to this seccion is pending or addiaona]data on the individual has been collected or created. The responsible authority shall provide eopies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and wmpiling the copies. 'Ihe responsble authoriry shall comply immediately,if possible,with any Rquest made pursuant to this subdivision,or within five days of the date of the nquest,ezcluding Saturdays,Sundays and legal holidays,if immediate compliaace is not possible. If he cannot compiy with the request within that ame,he shall so inform the individual,and may have an addidonal five 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 contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccumte or incomple�e data, including recipien�s named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in�dispute shall be disclosed only if the individual's statemtnt of disagreement is included with the disclosed data. 'Ihe determinaaon of the responsible authoriry 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,�o 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 ue notified that: 1. The information you furnish will be used to determine your qualification for the perm.it 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 wich other local, state or federal agencies to the extent necessary to process the pemut 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 I��1.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. S'o i�-ty �4'�'1'��V O So u N FI� Fint Middle I.ast �u�r� 4 4�� z�s 1��K�.-r- srr��.-r Address __�iu��u-Poc.�s 1rltil _ . SS¢_o_S (��z) 333- �bZo Ciry;:�:, • Y,��.��s�,� ; _ State , Zip'. Phone � - .. - _ .. .t.w'Yr,1'?"�.;.�"'g�--s,�`..�::i� � . - .. - � � - .-- � I understand m rights�as stated bove. . �� Signaa