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� f Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA Subd. 1. Type of data. The ri¢hts of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidendal data conceming himself shall be informed of: (a)the purpose and intended use of the requesced data within the collecting'state agency,poliacal subdivision,or sratewide system; (b)whether he may refuse ot is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the identiry of ocher persons or enddes authorized by state or federal law to receive the data. This requiremen[shall not apply when an individual is asked to supply invesrieadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or proper[v tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsibie authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to hicn and, if he desires, shall be informed of the content and meaning of chat data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereaher unless a dispute or acdon pursuant to chis secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subjec[of the data. The responsible authoriry may require the requesang person to pay the acrual cosu 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 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 request within that time,he shall so inform the individual,and may have an addiaonal 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 concerning himself. To exercise this right,an individual shall nodfy in wriang 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 norify past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)noUfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disdosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of ihe administrarive procedure act reladng 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 deny the pemut or license. 3, The information may be shared with other local, state or federal agencies to the ex[ent necessary to process the pemut 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. � i � C� �—� 1� � L Gi � )1 E �i First �, � Middlz Last �� (r �, � {''� �- l� r � (�-� v'-t-'� � � � / � Aaaress �� -� � •� C �, �( �� G' C� -� � ,.� � � , �� .�� �,' _ C�� State Zip Phone I understand my rights as stated above. � ,.� � - � "�' �' ` �` � � . � � � Signature