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r � ' Sec.13.04 RIGHTS OF SLBJECTS OF D�T:� Suod. 1. T}•pe of data. The n�hrs of individual on whom che data is scored or to be stored shall be as set forth in this secdon. Subd.�. Information required to be�iven indicidual. .-�n individual asked to suppty private or conY�dendal dara concerning'tiimse(f shall be inrormed of: (a) �he purpose and incended use oi the r:auested da[a wi[hin the collecting"state agency, polincal subdivisioa, or stacewide rys[em; (b)whethzr he may refuse er is leeally required to suopiy tae:equesced daea:(c)any imown consequence arisin;from his supplying or refusing to supply priva[e or confiden[ial data:and(d)[he identicy of other�rsons or enades au�horized by state or federal law co receive the data. This requirement shall not apply when an individual is asked [o suppty invesngsave da[a. rursuan[to secdon 13.82, suodivision�, to a 1aw enforemen[o�cer. The commissiorer oi rever.ue ma� �lac� •^ �o�ce reauired under �his subdi�ision in !he individual ir.com� caz or orooem �ax refu^d instructions ins[ead ot on ��ose rorms. Subd. 3. .�ccess to data by individual. L'oon reouesc to a responsibfe au[honry,an individual shall be iniormed whether he is the subject ot stored data on individuals, and whether ic is classined�s puolic, pnva�e or conridendal. lipon his Curther request, an individual who is the subjec[ of stored private or public data on individuals shall be snown �he daea wichout any charge to him and, if he desires, shall be informed oi the content and meaning of that daca. .�fter an individual has be�n shown[he privace daea and informed of ia meaning,the da[a need not be disclosed ro hun for six months thereafter unless a disouce or aaion oursuan[�o �his sec[ion is pending or additio�al data on the individual has been collected or creaced. The responsible authoriry shall provide copies of the pnca[e or puolic daea upon request by the individual subject of rhe data. The responsiote aurhoriry may require the requesvne person to pay the actual cosa of making, ceroiyine, and compilin� rhe copies. The responsible authoricy shall compty immedia[ely, ii possible, wich any request made pursuant ro this subdivision, or wirhin tive days oi the date ot the requzst, excluding Sa�urdays,Sundays and l:zal holidays, if immediate compliance is no[possible. If he canno[comply with the request within eha[time,he shall so iniorm the individual,and r.iay have an additional five days within which to compty wirh the request,exciuding Sa[urdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may con�est the accuracy or completeness of public or private data concernine himszlf. To exercise�his neht,an individual shall no�ity in wricing the responsible authori[y descnbin3[he nacure of the disagreemenc. The responsibte au�horiry shall within�0 days eicher: ia)correct the data found to be inaccurace or incomplete and aaempt to norify past recipieats of inaccurate or incomplete data, includine recipients named by che individuat: or(b) nodfy the individual tha[he beLeves the data to be correct. Data in dispute shall be disclosed only if the individual's se.:cemen[of disagreement is included witn the disclosed data. The determinacion of the responsible au�horiry may be appealed pursuanc to �he provisions ot the admuusaadve procedure act rela�ing to contested cases. D:�T:� PRIVACY �DVISORY In accordance with M.S. 13.04, Subd. �, "Ri�h[s of subjeccs of data", we w•ould like to inform you that your request for a permit or iicense irom the Ciry ot Orono or any of its departments may require you to furnish certain private or confidential information. r ou a�e no�ified tnat: i. The information you furnish wiil be used to de[ermine your qualification for the permit 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 wirh ocher local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requeste� permit or license requires Council action to approve, some information may become public. 5, You have certain riohts under �1.5. 13.04 (available upon request) to revie�v private data on yourself. 6. Your full name is required to process this application or pemut. � � ��, G E �+ �_ - C �,, � , _S � :- First `iiddle Lasc ZZ `� � ��LI�� F � i��,� Address �� LL �j�� 1Nl Y' ' � 7 j�I � �'�1 � ��1 �_ C�n, State Zip Phone I under t y righ� as stated above. Signa[ure �--