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. � Stc.13.01 RIGHTS OF SUBJECTS OF DaTa Subd. 1. Type oE data. 'Ihe riehts of ir.dividual on whom[be data is stored or co be stored shall be as set for[h in this section. Subd.'_. Information reqirired to be�ven individual. An individual asked to suppiy private or confidendai dara concecning himself shall be informed of: (a)che purpose and incended use of che requested dara wi[hin[he cotlecang state a,eacy,political subdivision,or sratewide system; �b)whe[her he may refuse oi is(egally requiced ro supply[he reques�ed data:(c)any fmown consequence arising from his supplying or refusing to supply privace or conndenrial dara;and(d)the idenaty of ocher persoas or endaes authorized by scate or federal law to receive the data. This requiremenc shall not apply when an individual is asl:ed to supply in�'esrieaave data, pursuant ro section 13.82, subdivision 5, to a law enforcement o�cer. The comriissioner of re�enue mav pla-� che noace reauired under this subdivision in the individual income tax or properev raz refund instrucrions instezd of on those forms. Subd. 3. access to data bc indi�ldual. lipon request to a responsible authoriry,an individual shall be informed whether he is the subjecc of stored data on individuals,and wheeher it is classuied as public, priva�e or confidendal. lipon his funher request, an individual who is the subjecc of stored privace or public dara on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the concen� and meaning of rhat dara. After an individual has been shown[he privace data and informed of its meaning,the data need not be disclosed to him for six months[hereaftec unless a dispute or acrion pursuan[to this secrion is pending or addiaonal data on the individual has been collected or created. The responsible au[horiry shall provide copies of rhe privace or public data upon request by the individual subject of the dara. The responsible authoriry may require[he requesring person to pay [he acolal costs of making. cerrifying, and compiling the copies. The responsiblz authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or wi[hin five days of the date of tha request,exctuding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request wichut that time,he shail so inform the individual,and may have an addiaonal five days wi[hin which to comply with[he request,exc!uding Saturdays, 5undays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himsetf. To exercise�his rieht,an individual shall nodfy in wridng che responsible authoriry dzscribing the nature of the disagreement. The responsible auchoricy shall within 30 days ei�':er. (a)correct che data found ro be inaccurace or incomplete and attempt to nodfy past recipiencs of inaccurate or incomplece data, including recipiea�s named by the individual; or(b)nodfy the individual that he believes the dara to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[erminadon of the responsible au[horiry may be appealed pursuant to the provisions of the administrarive procedure act relaang to contested cases. DATA 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 Ciry of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1, The informa[ion you furnish will be used to determine your qualification for the pemut or license requested. ?. 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 a�encies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. j. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. , �; �,� �'_ � ` l �' 1 G � �st Firsc ' .d z -� � � ��1�� j � �� � 1 ' �,a�rq�s��•�{} r;� 1�1''1 �� `-��r�� —a�c�� ,� � � ��-�f � � � Ciry State Zip �Phonz I understand �y ��h s as ated above. r � �' �. Sigr�antre