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� Y ¢� Sec.13.0-i RIGH'TS OF SUBJECTS OF DATA Subd. 1. Type of data. The righ�s of individual on whom rhe data is stored or to be stored shall be as sec forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a) the purpose and intended use of the requested dara wi[hin the collecang'state agency, polidcal subdivision,or srarewide sysum: (b)whe�her he may refuse or is legally required to supply che requested data;(c)any lmown consequence arising from his supplying or refusing to suppty pnva�e or conndendal data;and(d)che idend[y of o[her persons or entides authorized by state or federal law to teceive the dara. Ihis requirement shall no[apply when an individual is asked to supply invesdgadve dan, pursuant to secdon 13.82, subdivision�, ro a law eaiorcement officer. The commissoner of revenue mav Iace [he nonce reauired unde� this subdivision in the individual income raz or orooem taz refur.d ins�rucrions instead oP on those forms. Subd. 3. Access to data by individual. Upon request to a responsible auehoriry,an individual shall be informed whecher he is[he subject of stored data on individuals, and whether ic is classiFied as puolic, priva[e or contidential. Upon his fur[her request, an individual who is the subjecc ot stored pnva[e or public dara on individuals shall be shown�he data wichou[any charge to him and, if he desires, shall be informed of rhe conten� and meaning of that data. After an individual has been shown[he pnva�e data and inYormed or'i[s meaning, che dara need not be disclosed ro him for six monchs thereafter uriless a dispute or action pursuant to this secnon is pending or addidonal da[a on the individual has been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by che individual subject oT[he data. The responsibfe au[horiry may require che requesting penon ro pay the accual costs of making, cernryin¢, and compiling the copies. The responsible authority shall comply immediately, if possible, with any reques[made pursuanc ro[his subdivision, or wirhin five days of the da[e of che request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is noc possible. If he canno�comply wi[h che requesz wi[hin eha[ame,he shall so inform the individual,and may have an addiaonal Five days within which to comply wi[h the requesc,excluding Sarurdays, Sundays and leeal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conces[the accuracy or comple[eness of pub(ic or priva[e data concerning himself. To exercise this right,an individual shail noafy in wricing che responsible authority describing[he na[ure of[he disagreemenc. The responsible auchonry shall within 30 days eicher. (a)correcc the data found to be inaccurate or incomplete and attempt co nodfy past recipienes of inaccurate or incomplete data, including recipients named by �he individual; or(b) notify the individual thac he beiieves the data to be correct. Data in dispu[e shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data. Tne determinadon of[he responsiole auchoriry may be appealed pursuan[to the provisions of the administradve procedure act reladng to contested cases. DATA PRIVACY :�DVISORY In accordance wich M.S. 13.04, Subd. 2, "Riahts of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its depanments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to deternune your qualification for the permit or license requested. 2. You may refuse ro 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 exten[ necessary to process the permit or license. 4. If your requested pernut or license requires Council action to approve, some informa[ion may become public. j. You have cercain rights under M.S. 13.04 (available upon request) to review priva�e da�a on yourself. 6. Your full name is required to process this application or permit. .`��.�S��v �l�� t-�4� i�l Z.�L Fiac vtiddle ��11�c ��wr�c��-i � � �ddress - (� ) r� C �(Z�1� 1�1 1 /L±/� � c��5 3�� 7 f� O �/� c7'S - Ciry Sta[e Zip Phone I understand my rights as stated above. � ��, . �� J � signacu�e �