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. Scc.13.0�1 R[GEITS OF SUBJECTS OF DATA Subd. l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himselfshalf be informed of. (a)the purpose and intended use ofthe requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is leeally required to supply d�e requested data;(c)any known consequence arising Yrom his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by stare or federal law to receive the data. This requirement shal I not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcemen[officer. The commissioner of revenue mav place the notice required�mder this subdivision in the individual income tax or prooerty ta�retimd instructions instead of on those forms. Subd.3. Access to data by individual. Upon requestto a responsible authoriry,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed ofthe content and meaning of that data. After an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been coflected or creared. The responsible authority shall provide copies of the private or public data upon request by die individual subject of the data. The responsible aufhoriN may require the requesting person to pay die actual costs of making certiYying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or witl�in tive days of the date of the request,e�cluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot comply with the request within that time,he shall so inform the individual,and may have an additional tive days within�vhich to comply with[he request,excluding Sacurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or private data concerning himself. To eeercise this ri�ht,an individual shall notify in writing the responsible authoriry describing the nature af d�e disagreemen[.The responsible authority shall within 30 days eithec (a)correct the data found to be inaccurate or incomplete and attempt to notif'y past recipients of inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included�vith the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to inforn�you that your request for a pern�it or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: l. The information you furnish will be used to determine your qualification for the permit or license requested. 2. 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 agencies 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. 5. You have certain ri;hts under l�t.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�i �C�e�l �J�e ��i��e�c� First �Iiddlc Last 31�0 /h��n�� c� .4ddress (,Jc�-�Pz�.f-a l�?�U �53�� /� 1�� 2��5 Cil}' State lip Phane I understand mV rights as stated above. //� Sign.�turc ReseC Form 3�