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. Sec.13.Q4 RIGFTTS OF SLJB,JECTS OF DaTa ' Subd. 1. Type of data. The righcs of individual on whom[he data is scorcd or to be scored shall be as sec forch ia this secrion. Subd.2. Iaformation reqirired to be given individual. An individual asYed to supply privare or confideadal data concerniag himself shall be informcd of: (a)[he purpose and in[ended use of the requesied dara wichin the collecaag�tate age�cy, polidcal subdivision,or stacewide rys[em; (b)whe�:er he tnay refuse or is.legally requir.d to supply[he requesud data;(c)any Imown caasequence arising from his supplying or refusing to supply priva�e or conndenrial data;and(d)the idenary of other penoas or enddes au[horized by state or fedecal law to rcceive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dan,pursuan�to sccdon 13.82,subdivision S, co a faw enforcemeat o�cer. The eecnmissioner of revenu� mav pla^� the nodc- rauired und-r this subdivision in the individual income taz or prooem taz refund inscrucdons inscead of on those forms. Su6d. 3. Access to data by individual. Upon requesc to a responsible au[horiry,an individual shall be informed whather he is rhe subject of stor:d daci on individuals,and whecher it is class�:d as pubiic,private or confidendal. Upon his further request, an individual who is the subjec� of stor.d�rivate or public dara on individuals shall be shown[he dara wirhout any charge to him and;if he desires, shall be informed of the contznt and meaning of chat data. After an individual has been shown the private dara and informed of ict meaniag,the dara need not be d'uclosed ro him for siz monchs thereafter unless a dispute or acdon pursuanc co this secdon is pending or addidoaal dara on the individual has been collec[rd or creared. 'Ihe responsible authoriry shall provide copies of the priva�e or public data uFon request by the individual subject of the dara. 'Ihe responsible authoriry may require d:e requesdng per5on to pay the accual cosu oi making,cerrifying,and compiling the copies. The responsible auchoriry shall comply immediately,if possible,wich any request made pursuant to this subdivision,or within five days of the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with the request wichin that dme,he shall so inform the individual,and may have an addinonal five days wi[hin which to comply wich the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest tha accuracy or completeness of public or private dara conceming himself. To exercise[his right,an individual shait noafy in wridng che responsible authoriry describing the nacure of the d'uagreement. The responsible authoriry shall wichin 30 days ei�:er: (a)correc�rhe data found to be inaccurace or incomplece and aaempt to nodfy pasc recipienu of inaccurace or incomplae data, including recipien�s named by che individual; or(b)nodfy the individual tha[he believes rhe data to be correct Data in dispu�e shall be disclosed only if rhe individual's statemenc of disagreement is included with[he disclosed data. The decerminadon of the responsible auchoriry may be appealed pursuanc to the provisions of che administrarive procedure act relaring to contesud cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Righcs of subjects of data", we would like to inform you tha[your request for a permic or license from the City 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 detemune 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 informa[ion may be shared wich ocher local, stace or federal agencies to the ezcent necessary to process the pemu[ or license. 4. If your requested permit or license requires Council action to approve, some informa[ion may become public. 5. You have certain ri;hts under M.S. 13.04 (availabie upon request) to review private data on yourself. 6. Your full name is required to process this application or pecm.it. �j 0�-l� � v � �'(�C{.`F� C � S � u i Yl �. F� / l `I �Q�.� � � ��ddic�� Last � Addres �, �� I � i � V �� —( / (� �� L/ ` l � ( ��J' `�\� Ciry Sace Zip Phone I underspand ri;hts �s s[ated above. � �� Signacure