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� Sec.13.04 RIGHTS OF SUBJECI'S OF DA'I'A Subd.l. Type of dara. The nghts of individual on wh�m the data is stored or ro be stored shall be as set CoRh in ihis section. Subd.2. Information required to be given individual. An individual asked to supply pri��ate or confidential data conceming himselfshall lx inforrned oE (a)the puTpose and intended use of ihe requested data within the collecting state agency,pol itical subdivision,or statcwide system;(b) whether he may refuse or is icgally required to supply the requested data;(c)am know�n consequence arising from his supplying or refusing to supply privace or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigativz data,pursuant to section 13.82,sabdivision 5,to a law cnforcement officer_ The commissioner of revenue mavplace the notice reauired under this subdivision in the individual income tax r�roncr�v�ax refund instructions instead of on[hosc fortns. � Subd.3.Access ro data by indiviJual.Upon request ro a responsibleauthority,an individual shall be informcd�vhether he is Uie subject of srored data on individuals,nnd whe�her it is classifed as public,privute or confidential. Upon his further request,an individua!who is the subject of srored private or public data on individuals shalf be shown the dala H�ithout any charge to him and,if he desires,shaq be informed of the content and meanine of that data. Atter an individual h�s been shown the private data and informed of its meaning,the data need noc be disclosed to him for six mon[hs Ihereafter unless a dispute or action pursuant to this section is pending or add itional data on the individual has been collec�ed or creaied. ThC responsible authonty shall providc copies of the private or public data upon rzquest by thc individual subject of the data. The responsible authority may�equire the requesting person to pay the actual costs of making,certifying,and compiling the copics. 7�he responsible authorih�shall comply immediately,ifpossible,withany request made purs�ant ro this subdivis'ton,or within tive days of the date of the reques�excluding Saturdays,5undays and le2a]holidays,if immediate compliance is not possible.[fhe cannotcomply with the reques� within that time,he shall so inform the individual,and may have an additional five days«�itfiin�vhich to comply�tii[h thc request,exduding Saturdays, Sundays and legal holidavs. Subd.4. Procedurc when data is na�accwace orcomplete.An individual may concestthe accuracy or compleeeness ofpubfic or private data eonceminghimself. Toesercisethisright,anindividualshallnotifyinwritingtheresponsibleauthoritydescnbin�thenatureofthedisaereemenc The responsi6le authority shall within 30 days cither: (a)correct the data found to be inaccurate or incomplete and attempt to notif}•past recipienu of inaccurate or fncomplete dala,including recipients named by the individual;or(b)notify Lhe indi��idual tha�he believes che data to be correcl. Data in dispute shall be disclosed only iCthe individual's statement ofdisagr�ment is included H�ith[he disclosed data. The determination of the responsible au�hority may be appealed pursuanc to thz provisions of the adminisvative procedurc act relating to contested cases. DATA PRIVACY ADVISORY in accordance with M.S.13.04.Subd.2,"Rights of subjects of data",we w�ould 1 ike to in(orm.�ou that your request for a permit or license from lhe City of Orono or any of its deparcmenis may require you to fumish certain private or confidential inforrnation. You are notified that: l. The 'snformation you furnish will be used to deterrnine r•our qualification for the permit or licensc requested. 2. You may refuse to supply data,but refusal may reyuire tha�the City dcny [he permit or ticense. 3. The information may be shared�aith other local. state or federa] agencies to ihe extent necessary to proccss the permi[or license. 4. [f your reques�ed peRnit or license requires Council ac�ion to approve, some information may become public. 5. You have certain righ[s under M.S. 13.04(avai(able upon request)to review private da[a on yoursclf. 6. Your fu11 name is cequired to process this application or permit. {`�t�s�L �Pl�� e�-�e�- First Middle Last �pvJ � • Z�� 5� ' Address �'>�`^�'� 'MN� 5 S03 3 �I z- y19-/O S� C�� Sta[e 7,ip Phone I understand ri s as stated ove. Signature Reset Form 32 z 'd dSi =zO LO 80 Ga�