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Sec.13.0�RIGH'TS OF SUB.lECTS OF DaT�1 Subd. 1. Type of data. The righ[s of individual on whom[he data is stored or co be scored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. .�.n individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and in[ended use of the requested data within the collecting'state agency,poliacal subdivision,or sratewide system; (b)whe[her he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supp(y priva[e or confidenrial data;and(d)the idenriry of other persons or enriries authorized by state or federal law to receive the data. This requirement shall no[apply when an indieidual is asked to suppiy investiearive dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue riav place the norice reauired under this subdivision in the individual income_tax or propem tax refund instruc[ions insrezd ot on those forms. Subd. 3. Access to data by indi�zdual. Upon reques[to a responsib(e authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether 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�he data wi�hout any charge to him and, if he desires, shall be informed of the contenc and meaning uY'chat data. Afrer an individual has been shown che priva[e data and informed of iu meaning,the data need not be disclosed to him for six months thereaher unless a dispute or acrion pursuant to this secaon is pending or addidonal data on the individual has been collected or crea[ed. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of che data. The responsible authoriry may require the requesting person to pay [he actual cosu of makine, cerdfying, 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 Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request wi[hin 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 hotidays. 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 this right,an individual shall noafy in wriang che responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall wi[hin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomp(ere data, inc(uding recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disc(osed only if the individual's statement of disagreement is included with the disclosed data. Tiie determination of the responsible au[horiry may be appealed pursuant to the provisions of the administradve procedure act relatine to contes[ed cases. DAT�, PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit 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. j. 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. "'�-��-�`/ � 14�.►L �i IL_!�� First �iiddle Las[ S� C�, ��l►'�� -�.� Address � �"-�-r 6�nv� ��; �`� � ; 1� �J ) 4� 7 -`�-� ��ty Stare Zip Phone I underst my ri stated abov � �� , � J> � Signature