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Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. I. Type o!data. The righcs of individual on whom the daca is stored or to bc stored shall be as set forth in this scction. Subd. 2. Information required to be given tndividual. M individual asked to supply private or confideaoal data concerning himx�f shall bc informed of: (a)[he purpose and intended use of the requuted data withur the collecung�eate agency, pofitical subd�vision,or statewide rystem; (b)whecher he may refuse or is Icgaliy rcquircd to suppfy the'rcquested data;(c)any known consequence arising frotn tus suppfying or refusing to;upP�y pnvate or confidenaal daa;and(d)the idenpry of other persons or endties'authorized by sratc or fcdccal law co recefve the data. 'Ihisroquirement shall no�apply when an individual is askcd to supply invesdgadve data, pursuant to secdon 13.82, subdivisioa 5, to a law enforcemenCofficer. The commissioner of revenue ma lace the notice re uircd under this subdivision in the individual income tax or ro taz rcfund inswcnons inscead of on those forms. , Subd. 3. Access to data by indiv{dua1, Upon rcquest to a responsible au[hority,an individual s6all be informed whether he is the subject of scored daca on individuals,and whether it is classified as public, privace or co�denoal. Upon his fucther request,an individual who is the subject of scored private or public data on individuals shall be shown the data without,any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. After�an individual has been shown the priva[e data and informed of iu meaning, the data need not be disclosed to him for siz mon�hs �hereafter unless a dispum or acdon pursuane co this sec[ion is pe�ing or addidonal data on[he iwdividual has been coUected or crcated. The responsible auchoriry shall provide copies of the private or public daca upon 2quest by the individual subject of the data. 'Ibe responsibte auchoriry may require [he rcquesting person to pay the actual costs of making, cervfying,and compiling[he copies. The responsibte auchoriry shall comply immediatcly, if possible, with any rcquest made pursuant to[his subdivision,or within five days of che da�e of che request,ezcluding Satu�days,Sundays and legal holidays,if immediate compliance is not possible. If he carwot comply with the request wichin chat time, he shall so infortn the individual,and may have an addirional five days wi[hin which to comply with the request,ezcluding Saturdays, Sundays and legal holidays. Subd. 4. Procedure when data is not accurate or complete. An individual may concest the accuracy or compleceneu of public or privace data concerning himself. To exer�isc this right,an individual shall noafy in wridng the rcsponsible authoriry describing the nawre of�e disagreemenc. "Il�e responsible au�horiry shall within 30 days either: (a)correct the da�a found to be inaccurate or incomplete and actempt to notify past recipieots of inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the indi�•idual that he believes the data to be correct. Data in dispu�e shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[ermination of[he responsible authority may be appealed pursuanc�o the provisions of[he administracive procedure act refaang �o contested casts. DATA PRIVACY ADVISORY [n accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request for a permic or license from the City of Orono or any of its departments may require you to furnish certain private or con�dential information. . You are notified that: I. The information you furnish will be used to deternune your qualification for the permit or license requested. Z. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be�hared with other local, state or federal agencies to the exteat 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 cenain rights under M.S. 13.04 (available upon request) to review private data on yourself. b. Your full name is required to process this application or pernut. , � • � F'Rt Middle "� ("ICTI(:: '-��- L.ast • 1�G l:� i�4Y: ; -7 , - Address 1 ►.-f; ;� �, ��,( ��; t�-L� sS�y� ��a � �tW��1 c'ry staco Z�P Phone un rs and my righ[s as st o . Signa�ure � � -� ��