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� , � Sea13.0;RIGHTS OF SUBJECTS OF DATa Subd. 1. Type of daca. The riehcs of ir,dividual on whom the data is stored or to be stored shall be as set forth in this secaoo. � Subd.2. Information reqirired to be given indicidual. An individua!asked to suppiy privare or eonfideaaal dara coacerni.og himseif sball be informed of: (a)the purpose and incended use of che requesc�dara within the eollecang 3ta�ageacy, poliacat subdivision,or sacewide rystem; (b)wheche�he may refuse or is legally requir.d co supply the rquested dac3;(c)aay lrnown coasequeace arising from his supplying or refusing to supply private or eonndendal data;ar.d(d)the idanary of other parsoas or enrides authoriz:d by sc3t`or federal law to r.ceive the dara. 'Ihis requucmeat shall not apply when an individua]is asked to supply invadgaave dara,pursuant to secaon 13.83,subdivision 5, to a law enfor�ement ofricer. - Thz eommissioner of tevenue mav olace u`te noace r_ouir:d under ths subdivision in [he individu:l ir.come tax or orooem az ttfued inscrucdons inscz�d of on chose forms. Subd.3. Access to data by indi�idual. lipon request to a responsible au�horiry,an individual shall be informed whe�her tie is tha subject � of scored da[a on individuals,and whechzr it is ciassified as pubtic, private or co�denaal. Upon his further reques�,an individua!who is the subject of stored private or public daca on individuals shall be shown the dati wi�hout any charge co him and,-if he d�sires, shall be informed of che concenc and meaning of that dara. Afrer an individual has been shown t�e priva�,data and informed of ics meaning, che dara need not be disclosed to hira for six monetu therea[cer unIas a dispute or acrion puauanc to ttiis secaon is panding or addiconal daca oa the ir.dividual has been collecced or creaced. Zhe responsible authoriry shall provide copies of the privace or public data upon requese by��e individua!subje:c of che data. Tne responsible auchoriry may requir the requesring person to pay the acnial coscs of rr�king,cerafying, and compiling the copics. 'Ihe responsibla au[horiry shall eomply immediately, if possible, wi[h any rzquest made pursuant to chis subdivision,or wi[hin five days of the date of[he request,excluding Saturdays,Sundays and legal holidays,if immediace compliaace is not possible. If he cannot comply wi[h the requesc wichin[hat time,he shall so inform the individual,and may have an addiaonal fivt days witfiin which to comply with the request,e�cluding 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 o�priti•ate dara concerning himself. To exercise chis ri¢hc,an individuai shall nod"ry in wriang che responsibla authoriry d:scribing the nacure of the disagreemen�. The responsible authoriry shall within 30 days either: (a)corrcc the data found to be inaccurate or incomplece and aaempt to nodfy past recipieats of inaccurate or incomplete data, including recipiena named by rhe individual; or(b)aodfy t�'�e individual thac he believes [he data to be correcc. Data in dispuce shall be disclosed only if the individual's sc3cemenc of disagreement is included with the disclosed dac�. The decerminarion of the rzsponsible authoriry may be appealtd pursuanc to tt:a provisions of the zdminis�acive procedure act relaaag to contesced eases. DATA PRiVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "Riohcs of subjects of data", we would like to inform you that your request for a permit or license from the Ciry of Orono oc� any of its depa.rtments may require you to fumish certain private or confidential information. You are notified that:� 1. The information you furnish will be used to determine your qualification fo;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 shared with ocher 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 informa[ion may become public. �. You have certain rishts under M.S. 13.04 (available upon request) to review private data onyouurself. 6. Your fu11 name is required to process this applicatio❑ or permit. � �__ � �� I . ,,� _ � `.. _ Firsc ,� �� --- � �fiddle _^ sc �� .� Address � � �+�; .>>-.�c-1 I �d 1 ( �"r�` Ciry Sca�. Zip P6one - I understand my ri�hts as stated above. Signature