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� , _ Sec.I3.04 RIGHTS OF SIIB.TECTS OF DATA Subd. l. Type of data. 'R�c rights of individual on whom the data is stored or to be stored shall be as set forth in this ucoon. Subd.2. Informatioa requtnd to be givea lndiridual. M individua!asked to supply private or confidenaal data concerning himxlf shall be informed of: (a)the purpose and inteaded use of the requcsted daa withur the collccdng Yute agency, poliacal subdivision,or statewide rystem; (b)whenc�r he may rofuse or is legally rcquimA to supply the`�squuted data;(c)any known coosequence arising frotn his supplyin�or refusing to;uppiy private or confidential data;uid(d)the identity"of ofher persons or eatides'authorizcd by statc or federal law W receive the data. Thit requirement shall not�pply when an individuaP is uked to supply invutigative data, punvant ro xcnoa 13.82,subdivuioa 5, to a law enfoteemenf officer. The commissioner of revemu may place the notice rcauired under this subdivision in the individual income tax or vropem tax rcfund inswcnons mstcad o!on thou fornu. Subd.3. Access to data by individual. Upon rcquest to z responsible authority,an individual shall be informed w6ether he is the subject of s�ored data on individuals,and whether it is classified as public,private or confidenrial. Upon 6is further request,an individual who is the subjccc , of storcd pmzte o�public data o�individuals shall be shown the data without,any charge to him and, if he desires, shall be informed of the con[cnt . and mcaning of chat daa. Ahc��an individual has bce�shown[he private dan and info�med of its meaning,the data need not be disclostd to him for six monchs thcreafur unless a dispute or action pursuanc to this secrion is pcnding or addiaona!daa oo tfie individual has betn coUected or c�ea�ed. The rcsponsible authority sdall provide copies of the private or public daa upon ccquest by the individual rubject of the data. 'Ibe responsible authoriry may requirc the requcsting person to pay the utusl costs of making,cerrifying,and compiling the copies. Thc resporuible authoriry shall comply immediately,if possible, with�ny rcquest madc pursuant to this subdivision,or witfiin five days of the date of the ttquest,excluding Saaidays.Sundays and legal holidays,if irtunediate compl'unce is aot possible. If 6e cannot comply with the requesc wirhin that cirne,he shall so inform the individual,ud may have an addidonal five days widiin which to comply with ehe cequest,excluding Satucdays, Sundays and legal holidays. Subd.4. Procedure when data is not acnuate or complete. An individual may contest the accuracy or completeneu of public or privace data concerning hirtuelf. To exer�ise dus right,an individual shall notify in wriang the rcsponsible authoriry des:ribing the natune of the disagreemenc. 'I�e responsible authoriry shall within 30 days either. (a)correct the data found to be inaccun[e or incompkte and aaempt to notify past recipieau of inaccurate or incomplete data, including rocipients named by the individual;or(b)notify the indi�•idual that he believes the data to be corrtct. Da�a in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detertnination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act rela6ng to con�es�ed cases. DATA PRIVACY ADVISORY [n 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 are notified that: l. The information you furnish will be used ro deternune 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;hared 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. L3.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. �'Vl l'l L S �Y'C'.0 i�'► LO�'1��].YY1 CA 1r� First . Middle- Last � _ 15�(;� 1-�-�;u v �T ned«ss 1"� l iil�1��O�'1�A 1�Y1 � ��S C'ry State Zip Phone [ un and my rights as ve. � -c' Signacure