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M r_ R . Sec.13.04 RIGHTS OF SUBTECTS OF D�,T?. Subd. 1. Type oE data. Tha ri¢h�s oF individual oa whom thc data is sror.3 or co be scord sha11 be u set for�4 in this secaon. Subd.2. Informatien reqirired to be�vea individual. An individual asked to suppty private or confideaaal dam concerning himseif shall be informed of: (a) the purpose aad incended ust of che request�da�within the colle:ang Yu;�ag:ocy, poliacal subdivision,or sntewide rystem; (b)whether he may rfuse or is le3ally cequi:e3 to suppiy the rquestcd dac3;(c)any lmown coasequenca arisin3 from his supplying or refusing to supply priva�e or conadenaal data;ar:d(d)che ideeary of o�her persoas orenddes auchoriz:d by scata or federal(aw to receive tha dam. This requiremeat s6a1t not apply when an individual is asked to suoply invesdoadve dara, pursuaac to secdon 13.82,subdivision 5, to a law enforcemanc ofiicer. - Th� com.,.issioner of revcnue nav olace th� noace r_auir.d under this subdivision in the individual income tax or orooem tax refur.d insrrucdor.s inscead of on chose forms. Subd. 3. Access to data by iadi�-idual. tipon rcquest to a responsibie auchoriry,an individual shall be informed whe�her he is[he subjecc � of scord daci on individuals,and whecher it is classified as pubiic, priva�e or confidenaal. Upon his further rcquesc,an individual who is the subjecc oF s�ored privace or public dac�on individuals shall ba shown[he daa wichouc any char3e to him and;if he desires, shall be informed of the concznc and meaning of chat dara. Ah�r an individual has been shown[he privac�data and inforsied of its meaning,the dara need not be disclosed to him for siz mon�hs[f:eceaccer unless a dispute or acdon pursuan�to [his secdon is ptnding or addidonai data on che individual�as beea collecced or cr:a�ed. The rsponsibla authoriry shall provide copies of the privace or public data upon request by the individual subjecc of chz data. The responsible aurhoriry may require che reques:ing pe�son to pay the accual cosu of m.aking,cerrifying,and compIling the copies. The responsible auchoriry shall comply immedia�ely,if possible, with any request made pursuant to this subdivision,or wichin five days of the dace of tha reques�,exciuding Sacurdays.Sundays and legal holidays,if immediate compliance is noc possible. If he canno[comply with the requesc wichin chat�e,he shall so inForm[he individual,and may have an addidonal fivo days within which to comply wich the requesc,e�cluding Sacurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or campiete. An individual may contest the accuracy or completeness of public orpri�•ate data cor.ceming hinself. To ezercise�his richc,an individual shail nori"ry in wridng�he responsiblc authoriry describing the nacure of the disagreemeac. The responsibl:auchoriry shall within 30 days either: (a)corr.0[he data found to be inaccurace or incomplece and attempt to nodfy past recipieacs of inaccuraca or incomplete daca, including re:ipien�s named by [he individual; or(b)r.odfy[he individual that he believes che data to be coaecG Data in dispuce shali ba disclosed only if the ir.dividual's sc3tem�nt of disagreement is included with the disclosed data. The decerminaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisaarive procedure act retaang to contesced cases. DATA PRIVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "Rights of subjects of data", we would li.ke to inform you that your request for a permit or license from the Ciry of Orono or any of its deparcments may require you to fumish cercain private or confidential information. l You are notified that:- 1. The information you furnish will be used to determ.ine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require tha[ the City deny the permit or license. 3. The information may be shared wich other local, state or federal a�encies to the ex[ent necessary to process � the permit or license. 4. If your requestecl permit or license requues Council actlbn to approve, some informa[ion maq become public. 5. You have certain rights under M.S. I3.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. ' �� Firsc _ �fiddle Last �'� i L" <� S7 � Address n �- '— , � �� Ciry Sate Zip Phane I unde�stand IIiy rigi�ts as sta[ed above. .� -? � �_�7 � � C % �.: ignature J,, _ C /