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Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. ]nformation required to be given individuaL An individual asked to supply private or confidential data conceming himselfshall be informed of (a)the purpose and intended use ofthe requcsted data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other persons or entities authorized by state or Yederal law to receive the data.This requirement shal I not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a law enforcement officer. The commissioner of revenue mav�lace the notice reyuired under this subdivision in the individual income tax or property ta�refund instructions mstead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible autliority,an individual shall be informed whe[her 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 disdosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay.the actual costs of making certifying and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five davs of the date ofthe request,excluding Saturdays,Sundays and legal holidays,ifiminediatecompliance is notpossible. Ifhe cannotcomply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply wi[h 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 writing theresponsible authoriry describing the nature ofthe disagreement The responsible authoriry shall within 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt[o notify past recipients of � inaceurate 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 disagceement is induded with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Rights 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 permit or license requested. 2 You may refuse to supply data, but refusal may require that the City den}�the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested pernlit or license requires Council action to approve, some information may become public. 5. 1'ou have certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. ��'�o r+-t A S ,ri4 vtit e 5 �,E�P,e c/ First �liddle Last 3yo /�A-F ST. Address ' �/�o � o j�/. SS3 s"� �i.2 - �.�o•o�s g Cit�� State Zip Phonc I understand my rights as stated above. �— 1 Signature � Reset Fonn 3?