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Sec.1,3 04 RICH'TS OF SUBJECTS OF DATA , � �� Subdivision 1. Type ojdata The rights ojindividua!on whom the data is stored or to be stored shall be as set forlh in lhis section. Subd.2. Injormation required to be given individuaL An individua/asked 10 supply private or confiden�ial data concerning himselj sha!!be injormed oJ (aJ the purpose and intended use ojthe requested data wrthrn the collectrng state agency,politica!subdivrsion,or s�atewrde system;(b)whe�he�he may refuse or is lega!!y required lo supply�he reguested dala;(c)arry lorown consequence arrsing from his supplying or refusing to supply private or confrden�ral data;and(d)the idenlity oJother persons or entities authorized by state or federal/aw to receive the data. This�equiremenl shal!not apply when an individual is asked to supply investiga�ive data,pursuant to section 13.82, subdivision 5, to a!mv enjorcement o�cer. The commissroner ofrevenue mav Dlace the nolrce required under this subdivision in 1he individual income 1ax or p�operly tax rejund instruc�ions rnstead of on those fo�ms. Subd.3. Access to data by individuaL Upon request!o a responsible authority,an individual shal!be informed whether he is!he subject oJsJored data on individuals,and whether it is classrfied as public,private or confrden(ral. Upon his fur�her requesl,an individual who is the subject of stored private or pub/ic data on indivrduals sha!!be shown the data wilhout any cha�ge!o him and,ijhe desires,shall be informed of the conten!and meanrng oj�hat data. AJter an indivrdua!has been shown the prrvate data and infornred of rts meaning, the da�a need not be disc/osed to him for six montha thereafter unless a dispule or action pursuan!to this sec�ion is pending or additional data on the individual has been co!lected or created. The responsible authority shal!provide copies oJlhe privafe or public data upon request by the rndividual subject oj the da�a. The responsible authorrty may require Jhe requesting person to pay the acfual costs ojmaking,cert�ing,and compiling the copies. The resporuible authority sha!/comply rmmediately,ifpossible,wi�h a�ry requesf made pursuant to thrs subdivision,or wiJhinfive days of the date ojthe request,excluding Saturdays,Sundays and legal holydays,ijimmedrale compliance is not possrble. Ijhe cannof comply with the request within that�ime,he shal!so injorm!he indivrdua[,and may have an addrtional five days within which to comply with!he�equest,excluding Sa�u�days,Sundays and legal holydays. Subd 4. Procedure when data is not accurate or complete An individual may con►est the accuracy or completeness ofpublrc or prrvare data concernrng himse/f. To exercrse thrs right, an individual sha/1 notrfy in wrrling the responsible authorrty describing!he nalure oj the disagreement. The responsible au�hority shall withrn 30 days either: (a)correct�he datafound to be inaccurate or rncomplete and attempt to notify past recipien�s ojinaccurate or incomp/ete data,ixc/udingrecrpienls named by the indivrdual;or(6)not�1he rndividual that he believes the data to be correct. Data in dispu�e sha/16e disclosed only iflhe individua!'s slalement of disagreement is inc/uded with the disclosed data. � The determinalion oJthe resporrsib/e autho�ity may be appealed pursuant to�he provisrons oJ1he adminrstrative procedure act�elatrng to contested cases. DATA PRIVACYADVISORY In accordance wilh M.S.13.04.Su6d.2,"Rights ofsubjects ofdaJa",we would Irke to rnjorm you that your request jor a permit or license fiom lhe City of Orono or arry oJifs deparhnents may requi�e you toJurnish certain privale or confrdential information. Yau are nolrfred that: l. The injormation you furnish wil!be used to determine your qualificalion jor�he permit or/icense requested. 2. You may refuse to supply data,but refusal may require that the Crty deny the permrl or license. 3. The information may be shared wrth other local,slate or federa!agencies lo lhe exlenl necessary to process the permrt or license. 4. ljyour requested permit or license requires Council aclion to approve,some information may become publrc. 5. You have certain righls under M.S. 13.04(see fo!lowing page)!o revietiy private data on yourself. 6. Your fuJ!name is required to process this applica�ion or permit. PLEASE PRINT ��{,��GG��c�� < < ��'�=2��-�� First Middle Last c�l`� � ��i/�7�"- ��.1%/� Address �.L��7�i�}- ,��/L"� '� �`I� S�"� Ciry /� �� S1ate Zip Phoxe �� /ur�er land/nY ri�ns ale � - / � /�� , " ;;C/��-. l. / � Signature /0