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� Sec.13.04 RIGH'TS OF SUB.TECTS OF DATA Subd. I. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and in[ended use of the requested data wi�hin the collecting"state agency, polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or refusing to supply privace or confidential data;and(d)the identiry of o[her persons or endries authorized by state or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesrieadve dara,pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav ptace the noace reauired under this subdivision in the individuai income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidential. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafrer unless a dispute or acrion pursuant to �his secrion is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public dara upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual cosu of making, certifying, and compiling the copies. The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the reques[ within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding 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 or private data conceming himself. To exercise this right,an individual shall notify in wridng the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreemen[is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relating to contested cases. DATA PRNACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Riahts of subjects of 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 furnish certain private or confidential information. You are notified that: 1. The information you furnish 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 City deny the pemut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pernut 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 M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. � / L��Ty-i-/� ��,,,�� i�� T;�� --� First Middle Last S� 15 /L� ,�� a � � — Address ��, I Z Z !_ �� _� �Z y M �� ,��,�; �f i ��n, State Zip Phone I understan y ights as stated bo . �; — Signature