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08/15/2006 13:60 7632410395 DONE RITE RESTORATON PAGE 03104 Sec.a3.0a AIGH7'8 OF SUB.T�CTS OF AATa1, 5ubd.1. Type of dar�, The�igbts of individua�on whom the daca is stored or to be srored shaU be as se2 forth in this seccion. Subd.2. Information Cequired�be given individuaf.An individual askedto supply private or con�detltial dats conceming himselfshall be inEormed of. (a)the purpose and intended use oFthe requesced data within the cvllecting state agency>political subdivision,or sratewide system;(b) whether he m�y I'eCU9e oi is legal ly pequired to suDD�Y�he ieQuested datR;(c)any known consaquence atisine from his supplying or refusing to supply pri�B�e or confidential data;and(d)the identiry of otber persons or enti�ies suthorized by s�ce or federal lawto receive the data. This requiremene ehall not apply when an individual ig aeked to eupply inva9tigarive data,pucsuaz�t to gection 13,82,aubdivisioo 5,bo a law enforcement ofFiccr. The�ommissioner of revenue mav alace the notice ronuired under this subdivision in the individual ineome tax or orooem t��iefLntl inswc�ions instead of on chose fonns. 5ubd.3. Accass to dPta by individu�l, Upon fequesC to aresponsible authori�y.an individual shall be infoRned wheeher he is the subject oF swred data oo individuals,and whether ic is classified as public,p�ivate or conEidential. Upon his futther reques�an individual who is the subject of sto�d private or publie dats on individuals ahmll be shown thE dace without any eharge to h�m and,��he d�81C�8,sbsil bo informod of tho concen�aud meanin8 of thac dara. After an individual bag bpen sbown che private daw and informad of its meaning,the dap need noC be disclosed to him For 9ix mon�hs thereafter unless a dispuce or action pursuan[co rhis seccion is yending or additional dars on the individual has been collecCed or created. The responsible authority shall provide copies of the private or pubiic data upon requesc by the indi�iduaf subjecc ofthe data. I'he reeDonsib►e auchoriry may require the cequtsting person to pay the actual Costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,ifpoaeible,with any requeatmade purauant to this aubdivigion,oT withln��e days of the date ofthe reques�,cxcluding Saturdays,Sunday5 al�d lega►1t01iday9,if immediace compliance is not possible, Tfhe cannotcomply with the request wichin thaz time,he shal]50�nform thc individual,and may have an additionel five days within�✓riieh�o comply wj�b t11e t�equest,excluding Saturdays, Sundays and legal bolidays. Subd,4.Proeeduro when daYa is oot aeeurate or eomplete.An individual mr�y contest the accuracy or comyleocnaas�f�uhlie or private dara conceming himself.To exerciae chis ri8h�,an individual shall nocify in vKiting che responsible authority desc�ibin�the naCure ofthe disagreanenk The reeponeible authoriry ehall within 30 days either. (a)correct the data foand tq be inaccurate oP incomplete atld a�tempt to notify past recipicnu oF inaccuiate orincomplete daca,including recipients named bythe individual;or(b)notify the individual that hebelie.,es the data to be corrac�.Aars in dispute shall be disclosed only if the inQividuat's statament of Q�sa�greemenC is IncluQeQ with the disclosed data. The detcrmination of the responsibfe authority may be appealed pursuanl to tbe p[ovisions of tbe administiative plrocedu�e act relattngto contested cases. DATA PRIVACY ADVISORY 1n accordance with M.S.13.04,Subd.2,"Rights of subjeers o�daca",we would liketo in£orm you thet yourrequest for a permit or license frvm the City of Orono vr any o�its departm.er►ts rrlay�requiXe you to fut'r►ish cet'tain priva'te or confidential ink'ormation. You are notified that: �. The infornnation you �Cu�n,ish wi11 be used to determine your quali�cation for the pe�r►►t or license requested. 2. You may refuse to supply data,but refusa1 may require that the Cary deny ttae permit or license. 3. 7'he information may be shared with oth,er local, state or �'ederal agencies to ti�e extent necessary tio process the permit 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,p4(available uPon request)to review private data oz�you�self 6. Your full namo is required to proccss this application or permi . �/ � First � 1¢ Lest �� 7��3 1_�'�,�� Add�ess L�c. i2�- I�n s� �� 2-a� - � CI[y State zip Phone X upderstand p�y � bts as stated a 5i ature 41I(i � H;�i�i au 1,��P�ti:.4�S., �i �� r i i � i � � �'�n�"� �t � ' � ``' 32 �... `o'��i�,E�i+�+il ��',:,�