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i 11 f �� Sec.13.04 RIGHTS OF SUB.TECTS OF D�T?. Subd. i. Type of data. The righc�of ir.dividual on whom the daca is srored or to be s�ord shail be u set forth in this scc6on. = Subd.2. Informatioa reqiric�ed to be�ven indi�-iduai. P.n iadividual asked to suppiy private or co�denaal dara concerniag him.self shall be ieformed of: (a)che purpose and in[ended use of the requesr.�daca wichin[he collecdng�tac�agency,polidcal subdivuion,or sa�ewide rys.em; (b)whethzr he may r_;vse or is le3ally requiced to supply the r.quesud dac3;(c)any Irnown consequence arising from his supplying or refusing to supply priva�e or con.=cdenaal data;ar:d(d)the ideadry of ocher persoas or enddes a�chociz.d by scaca or federai law to receive the dara. 'Ihis requiremeat shall r.ot apply when an individual is asked ro supply invesd�aave dam,pursuan�to secdon 13.82,subdivision 5, to a law enforcemanc of�icer. - "iht commissioner of revenut mav olace th� norice r:ouir_d und�r this subdivision in the individuaI income ti�c or orovtm tax rtfued ins�ucaar.s ins�ead of on chose forms. Subd. 3. Access to data by indi.idual. Upon requesc to a responsible auchoriry,an individual shall bc inforraed whethec he is che subjecc � of scor_d dac�on individuals,and wh��her ic is classified as pubiic, privace or eonfidenaal. Upon his furcher request,an individual who is the subjec� of stoc:d private or public dac�on individuals shall be shown che dara wichout any charge to him and;if he desires, shall be inforcned of the eontent and meaning of that data. Aher an individual has been shown[he privace data and inforaied of ics meaning, tha dara need not be d'uclased to him for six monchs [t:ereafter uriless a dispuce or acaon pursuanc to chis secaon is ptnding or addiaonal data on the individual has been coliz:td or creaced. The responsib(:authoriry shall provide copies of the priva[e or public daca upon requese by che individual subjecc of cha data. The responsible au�horiry may require che reques:ing person to pay the accual coscs of ma3cing,cerdfying,and compiling the eopies. The responsibte auchoriry shall comply immediately,if possible,wi�h any requesc made pursuant to[his subdivision,or wi�hin five days of the date of�he requesc,ezciuding Sanirdays,Sundays and legal holidays,if immtdiate compliance is not possible. If he cannot comply with[he requesc wichin chat time,ho shall so inform[he individual,and may have an addidonal five days within which to comply wich the requesc,ezctuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or completeness of public o�pri�ate da�concerning hinse(f. To exercise this ri¢ht,an individual shail noa"ry in wridng the responsible au�horiry describing the nacure of the disagreement. The responsible authoriry shall wichin 30 days eicher: (a)correct the data found to be inaccurata ot incomplete ar.d attempc to nodfy past recipients of inaccurdte or incompleee data, inciuding recipiencs named by [he individual; or(b)nodfy the individual that he believes�he data to be correc� Data in dispuce shall be disclosed only if the individual's sc�tcment of disagreerr.ent is included with the disclosed dac�. The decerminaaon of the responsibl� au�horiry may be appealed pursuanc to che provisions of the adminiscrarive procedure act reladng to contesced eases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.Z, "Rig.hts of subjects of data", we would like to inform you that your request for a permit or license from the Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You aze notified that: � 1. The information you furnish will be used to determine 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 infocmation may be shared wich ocher local, state or federal a�encies [o the ex�ent necessary to process � the permit or license. 4. If your reques[ed permit or license requcres Council actlbn to approve, some information may become public. 5. You have certain ri�hts under M.S. 13.04 (available upon request) to review private da[a on yourself. 6. Your full name is required to process this application or permit. l��le�� /�7/4.S �Qr'�.�1�� — Firsc �fiddla Lasc '?�1 D _ ua Address A��l��-5.�� '/�/� ��l � //S �.�1_11_ �/ Ciry Srate Zip Phone I und�`rstand my ri�hts stated above. � 1 s�