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Sec.13.04 RIGHTS OF SLBJECTS OF D�T?. Subd. 1. Type of data. The neh[s of individual on whom�he data is stored or to be scored shall be as set focth in this secdon. Subd.2. Information required to be�ven indicidual. An individual asked[o supply private or confidendal dara conceming himself shall be informed of: (a)the purpose and incended use of the requested da[a wi[hin the cotlecdng'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is tegally required to supply che requested data;(c)any lmown consequence arising from his supplying or refusing[o supply priva[e or co�dential data;and(d)the idznaty of o[her persoas or enndes authorized by sta[e or federal law to receive[he data. This requirement shall not apply when an individual is asked ro supply invesdganve dara. pursuant to section 13.82, subdivision�, to a law enforcement o�cer. The commissioner oi revenue mav olace �ne .^.oece reauired under this subdivision in the individual income [sz or orooem taz refur.d instructions inscead of on[hose forms. Subd. 3. Access to data by individual. L'pon reauest to a responsible au[hority,an individual shall be in2ormed whether he is the subject of stored data on individuals, and whecher it is classiried as puolic, pnvate or contidenaal. lipon his further request, an individual who is thz subject of stored private or public data on individuals shall be shown[ae da[a wi�hout any charge to hun and, if he desires, shall be iniormed of the content and meaning of[hat data. Aher an individual has been shoµ�n che privace data and iniormed of iu meaning, the data need not be disclosed to him for six mon�hs[herea[ter unless a dispute or acnon pursuant m chis secdon is pending or addidoc�al data on che individual has been collected or crea[ed. The responsible auchonry shall provide copies of the pri�ar�or public data upon request by the individual suoject of the data. The responsible au[horirv may require the requestine person ro pay the actual costs of;nak:ng, cerdfyine, and compiling [he copies. The responsible au[horiry shall comply immediacely, if possible, with any request made pursuan[to this subdivision, or within five days of the date of the request, excluding Saturdays.Sundays and legai holidays, if immediate compliance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual, and may have an addidonal five days wi[hin which to comply with[he request, excluding Sa[urdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may concest the accuracy or completeness of public or private data concerning himself. To exercise this rieht,an indfvidual shall nonfy in wriring the responsible au[horiry describing che na[ure of the disa¢reement. The responsible authoriry shall within 30 days either. ;a)corr:ct the data found ro be inaccurate or incomple[e and attempt to nodfy past recipients of inaccurate or incomplete data, inciudin2 recipiena named by �he individuat: or(b)nod"ry the individual tha�he believes the data to be correc[. Da[a in dispu[e shall be disclosed only if the individual's s[acemenc of disaereement is included wi[h the disclosed data. The determination of the responsibie auchonry may be appealed pursuanc to the provisions of the administraave procedure act rela�ing to contes[ed cases. D�T� PRIVACY :�DVISORY In accordance with M.S. 13.04, Subd. 2, "Riancs of subjects oT data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. `:ou are no�ined .hat: 1. The information you fumish will be used to determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3, The information may be shared wi�h other local, sta[e 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 ti1.S. 13.04 (available upon request) to review private data on yourself. 6, Your full name is required to process this application or permit. �/'f"V�—^ ft � � ��f-�v��'R��-- First �i��'�z Las[ �� `(�- l S �l�-rl� (_._A-r� (�-� - Address 'Z� �5�-� � ��=' �'�-_ 6�� _ � -��z-� Ciry Stace Zip Phone I understand y rights as stated above. Signatur