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�' . Sec.13.04 RIGHTS OF SUB.JECTS OF DATA Subd. 1. Type of data. The ciehts of individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information required to be given individual. An individual asked to supply privace or confidenrial data co�cerning himself shall be informed of: (a) the purpose and intended use of the requested data within the collecting'state agency, poliacal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the reques[ed data;(c)any known consequence arising from his supplying or refusing to supply private or co�dential data;and(d)the idenary of other persons or entiaes au[horized by state or federal(aw to receive the data. This requirement shall not apply when an individual is asked to suppty invesriearive data, pur�an[ro secdon 13.82, subdivision�, ro a law enforcement officer. The commissioner of revenue mav place the nodce reouired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. �,ccess to data by individual. Upon request ro a responsible authoriry,an individual shall be informed whether he is the subject of stored da[a on individuals, and whe[her it is cfassified as public, private or confidenoal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrzr an individual has been shown[he private data and informed of its meaning, the data need not be disclosed to him for six mon[hs thereafter unless a dispute or action pursuan[to this section is pending or addirional data on[he individual has been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require[he requesting person to pay the actual costs of makine, cenifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of the date of the request,excluding 5aturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot compty with the request 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 pri�•ate data concerning himself. To exercise[his rieht,an individual shall notify in wriang the responsible authority describing[he nature of the disagreeme�t. The responsible authoriry shall within 30 days either. (a)correc[the data found ro be inaccurate or incomplete and attempt to nodfr•past recipienu of inaccurate or incomplete data, including recipients named by [he individual; or(b)notify the individual tha[he believes the data to be correc[. Data in dispute shall be disclosed only if[he individual's statement of disa;reement is included with the disclosed data. The determination of the rosponsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing to contested cases. DAT:� PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Riahts of subjects of data", we would like to inform you that your reauest 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 refusai may require that the City deny the pernut 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 pernut 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. 6. Your full name is required to process this application or permit. ��'G��'O'O�"I �.� ��fi%�/.y c�'��Gcis,� First �Sidd,lDz Las[ ��7U �/�l��Y //!/e �ddr//!/7 ��f� ��%�� .�7r� /�'C� 7,�� (��/f�� Ciry State Zip Phone I understand my r' hts tate bove` i ture