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. , Sec.13.04 RIGHTS OF SUBJECTS OF DATA ' Satd. 1. Type oC data. The righcs af individual an whom the data is stoced or co be smrd shalI be as sa forch ia this secrioa Subd.2. IaformaCon reqirired to be girm indlridual. An individuaI azk:d W supply privace ar coafidendal dam concerning himself shaIl be iaform:d of: (a)the purpase and intendcd use of the r�qucsud dan wichia tfie collecang�nm agenty,goliacal subd.ivisian,ar samwide sysc:m; (b)whec�e:he:..ay r::vse or u_legalIy tequir.d to supply,the rquesc:d data;(c}aay Imawn eonsequcnce arisiag from his supplyiag or refusing to suppiy privace or coarider.eal daa;and(d)the idenary of o�her per�oas or e:��_s a�•�ocized by s��e ar federal law to receive t�e da�a. This requiremene s�all not apply when an ir:dividua!is asked co supply invesagadve dam,pursuant to secdoa 13.8?,subdivision 5.�o a[aw enfoccemeac ofnce�. . - 'i�e ee:lmissioner of revenu� mav DI3Ce the noace re�uir_d under chis subdivision in the individual income taz oc orooercv taz refund insrrvcaons inscead of on those forms. Subd.3. �ecess to data by indiridual. Upon requesc to a responsible auchoriry,an individuaI shall be informed whether he it che subjecc of stor.d dan on individuals,and whe�her ic is e[ass�:d u public,privace or conFdenaal. Upaa his furcher r_quesc,an icdividuaI who is ehe subje:c of scor.d privace or public dara an individuais shall be shown che daa wichaut any charge to him and;if ha desira,shall be informed of the coatenc ar.d meaning of chat data. Afcer an individuai ha.s been shown the private dac�and informtd o[iet meaaing,the daca need not be d'uclosed to him for siz monchs�her.aFwr urless a dispuu o�acaon pursuan�to [his s::don is panding ar addidonal dac�on the individual has been collecc_d or crea`d. "Ihe respocuibte aurhoriry shall provide eopies of�he privam or public dara upon request by ehe individual subjecc oF che dam. The responsible auchoriry may requir_ che cequesang person to pay che accual eoscs ai making,ceccifying,and compiling the eopies. The responsible auehoriry shall eomply immediacety,if possible,wich any requesc made pur�uant to this subdivision,a�wi�hin five days of the date o[che request,ezcluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he eannoc comply with the requesc wichin chat dme,he shall so infocm[he individual,and may have an addidoaaI five days within which to comply wich the request,exciuding Sacurdays, Sundays and legal holidays. . � Subd.4. Praeedure when data is not accurate or eomplete. M ir.dividual may conc:sc the accuracy or compteteness of public or pri�•ate I dam conceming himself. To exercise this right,an individual shall noafy in wriaag[he responsible authociry describing the nature of the disagreemeac The responsibie authoriry shall wichin 30 days eichec (a)correct che dara found to be inaccurat-or incomplcte aad accempc to nodfy past recipien�s of i inaccuace or incomplece data, including recipients named by the individuaI:or(b)noafy the individual thac he believes the data to be correcG Dati � i in dispuce shali be disclosed only if the individuai's statemenc of disagreement is included wich the disclosed data. I The detecminaaon of the rtsponsiblz au�horiry may be appealed pursuant to the pcovisions of tht adminisaanve proc:duro act relating ro I concesc-d cases. • � DATA PRIVACY ADYISORY In accordance wich M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request I for a permit or license from the City of Orono or any of its depanments may require you to furnish ceRain private or confidential information. You are notified that: li 1. The information you furnish will be used to detemune your qualification for che permit or license requested. 2. You may refuse to suppty data, but refusal may require that the City deny the permit or license. 3. The information may be shared wich ocher local, stace or federal a�encies to the e�cent necessary to process the permit or license. � 4. If your requested permi[ or licease requires Council action to approve, some information may become public. 5. You have certain ri�hts under M.S. 13.04 (available upon request) to review priva[e data on yourself. 6. Your full narue is required to process chis applica�ion or permit. ��z c'G�— T'� �o v� �� c�- S Firsc // _ )�(iddle I.asc '7 � �v /Ylyh i.�t,S !i� - Add � �� f� � � -Syy Z 5S�- ��` -3 Ci Sate Zip P�oae I us nder�and my ri�hts as stated above. �� Sigrucure