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�� Sec.13.0�i RIGH'TS OF SLBJECTS OF D�Ta Subd. 1. Type of data. The righ�s of iadividual on whom rhe data is stored or co be stored shall be as set forrh in this section. Subd.'_. Information reqirired to be�ven individual. �+n individual asked ro supply privace or confidenaal dara conceming himseif shall be informed of: (a)the purpose and incended use of the requested data within the collecang'statc agency,polirical subdivision,or srdtewide rystem: (b)whe[her he may refuse oY is legally required ro supply tbe requested data;(c)any Irnown consequence arising from his supplyin�or refusing to supply private or conndenda!data;and(d)�he idennty of ocher peaons or ennoes authorized by sca�e or federal law to receive the data. This requiremeot shall no[apply when an individual is asked to supply invzsoeadve dara, pursuanc to secaon 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of re�e�ue mav pla- the noace reauired under this subdivision in the individual income tax or propertv taz refund instructions inscezd of on ehose forms. Subd. 3. Access to data b�individuaI. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe�er it is classified as public, private or confidenaal. L'pon his further request, an individual who is the subjecc of stered private or public dara on individuals shall be shown the data wirhout any cha,e co him and, if he desires, shall be informed of the concenc and meaning uf�hat data. Afrer an individual has been shown the private data and infomed oi its meaning,the data need not be disclosed to hun for six monrhs ehereafrer unless a dispute or acrion pu:suanc to chis secaon is pending or addiaooal dara on the individual has been collected or crea�ed. The responsible authoriry shall provide copies of che private or public data upon request by[he individual subject of che data. The responsible au[horiry may require[he requesting person to pay the acnial costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the dace of che reques�,exciuding Saturdays,Sundays and legal holidays,if immedia�e compliance is noc possible. If he cannot compiy with the reques� wi�hin�hac time,he shall so inform ehe individual,and may have an additional five days wich:n which co comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or camplete. An individual may contest the accuracy or comp(ereness of public or pri�•ate data conceming himself. To exercise this righ[,an individual shall nodfy in wridn;�he responsible authoriry describing the nacure of the disagreement. The responsible au[horiry shall within 30 days ei[l:er. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of inaccunte or incomplete dara, inciuding recipien�s named by the individual;or(b) nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disciosed data. The decerminarion of the responsible au�horiry may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 pemut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: 1. 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 pemut or license. ;. 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. �. You have certain rights under M.S. 13.04 (available upon request) [o review private data on yourself. 6, Your full name is required to process this application or permit. First �tiddlz Lasc ?�ddress Ciry State Zip Phone I understand my ri�hts as stated above. t �i /'C%�c%' �v� ��.s��/'�2-�,'�� Signature �