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t \ Sec.13.0�3 RIGHTS OF SUB.TECTS OF DATa Subd. 1. Type of data. The righcs o[iadividual ou whom the dan is scored or ro be sto�sd shall be�s set foct�;n this secdon. Subd.2. Information reqirired to be�ven individual. �n individual asked w supply privarL or confidendal dari.oacerning himself shall be informed of: (a)the purpose and imm�ded use of[he cequesred dard within the collecdng�rt agency,poliacal subdivis:ea,or satewide system; (b)whecher he taay rfuse or is legally tequired ro sunpty[he rtquested data:(c)any Irnown coauquence arising from his suppl�::g or refusing to supply privace or conndendal dara;and(d)the idenrity of ocher persoas or endries auchorized by stac_or federal law co receive che da�. This requiremeac shall not app[y when an individual is asked to supply ia�'esri¢adve daa, pursuanc ro secrion 13.82,subdivision 5, to a law enfor_�.ac o�cer. 'Ihe commissioner of r�e1u r-iav pla- che nodc- rauired under chis subdivision in rhe individua! income at or prooem raz refur.d inscrucdons insczad of on chose forms. Subd. 3. ?.ccess to data b�iadividuaI. lipon request to a responsibfe auchoriry,an individual shall be infocmed whe�her he is the subjecc of scor_d data on individuals,and whecher it is ci�csif:ed�s public, privace or confidendal. L'pon his funher request,an i�div:dual who is the subjecc of stored privace or pubtic daci on indir•iduals shall be shown[he data wichout any charge co him and,�if he desires, shall be iaiormed of the concenc and meaniag oi rhac dac►. Aher an individual hu been shown che privare dan and informed o[irs meaniag,the data need noc be disclosed m him for six mon�hs cheraiur uriless a dispuce or acrion pursuan�co ehis secrion is pending or addiaooai daci on�he individual has�e�a collec[ed or creaced. The responsibie au[horiry shall provid�copies of fie privace orpublic data upon requesc by rhe individual subjeccof�he daci. i�e responsible authoriry may require che requesdng person to pay che acnial coscs of making.cerrifying,and compiling [he copies. Tne responsibla auchoriry shall comply immediatety, if possible, wirh any request made pursuant to this subdivis:ea,or wi�hin five days oi the date of rha requesc,exciuding Sacucdays,Sundays and legsl holidays,if immediate complia�ce is noc possible. If he cannoc comply wi�h the reques� wichin chac dme,he shali so inform che iadividual,and may have an addidonal five days wirhin which co comply wich[he reqLcst,excluding Satucdays, Sundays and legsl holidays. Subd.4. Procedure when data is not accurste or complete. An individual may contest che accuracy or compler.^.ess of public or pri�•ate - dact conceming himself. To exer:ise chis righc,an individual shall nodfy in wridng che responsible aurhoriry describing[he naa;re of the disagreemeac. .. The responsiblz auchoriry shall wi[hin�0 days eic`.er: (a)correct[he data found co be inaccura�.or incomp(ece and aaempc;�nodfy pazt recipienrs of inaccurace or incomplece dara, inciuding recipiea�named by the individual; or(b)aorify [!:e individual cha[he believes[he dara to be car�ec. Data in dispuce shall be disc'.osed only if[he individual's statemene of disagreemenc is ir.cluded wieh[he disclosed dara. 'Ihe dzcerminaaon of the responsible auc.horiry may be appealed pursuanc to the provisions of chz adminisuarive �;o:.edure act relaring to contes:cd cases. DAT� PRIVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "RiQhts of subjecu of data", we wouid like to inforn you that your requesc for a permit or license from the City of Orono or any of i[s departments may require you to fumisa certain private or confidencial information. You are notified that: 1. The information you fumish will be used to determine your qualifica[ion for the pecmi�or license requested. ?. You may refuse to supply data, but refusai may require tha� che Ciry deny the permit or license. ;. The informacion may be shared with ocher local, sta[e or federal agencies to the extent necessary to process the permit or license. :}. If your requested perm.it or license requires Council action to approve, some infor.nation may become public. 5. You have certain ri�hcs under �i.S. 13.04 (available upon request) to review privatz data on yourself. (, Your full name is required to process this applicacion or permit. � �G/✓t-e( ��/✓i�� ci✓»o� _ Fint �ilddle Last J�� C' � �ddress I,t/a>/z •s �� ,/y1 n 5 5`3 i/ //z - 7i� -7:��f� Ciry Smce Zip Ptc�.. I understand my ri;hcs as staced above. � Signa ro