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_� Sec.13.Q4 RIGHTS OF SUBJECTS OF D:�Ta Subd. i. Type of data. The rieh�s of individual on whom the data is scored or to ba scord shall be as set fonh in this secdon. Subd.2. InformaQon reqirired to be givea individual. ?.n individuai asked to supply private or confidznaal daca coacerniag himseif shall be informed oF: (a)che purpose aad iar:nded use of the requesr�da�withia the collecdng�ta[e ageacy,poliacal subdivisioo,or sra[ewide ryscem; (b)whuher he may rfuse or is le3ally requi::d to supply the r.quuced dac3;(c)any Imown consequence arising from his supplyiag or refusing to supply priva[e or conndenaaI data;and(d)the idaadry o€other parsoas or enrid:s auchorized by sta[a or federal law to receive tha data. This requiremeat shall not apply when an individual is asked to suppiy invesd�aave dara,pursuanc to secdon 13.82,subdivision 5, to a law enforcemeac oE�icer. - Tha commissioner of revenue mav vlace cha noace r_auir_d under ehis subdivision in the individual income rax or orooem ax refund inscrucdons inst�ad oF on chasa forms. Subd. 3. Access to data by indirzdual, tipon requcsc to a responsible au�horiry,aq individual shall be informed whecher he is the subject � of scord dact on individuals,and whzcher ic is elassified as public,privace or confedenrial. Upon his furcher requesc,aa individual who is the subjecc of scored privace or public data on individuals shall be shown che dati wichouc any charge to him and;if he desires, shall be infocmed of che contenc and meaning of chac da�a. Aher an individu�l has been shown the privace dara and informed of its meaning,cfie dara ne:d not be d'uclosed to him for six monchs[2:erea[trr unless a dispute or acdon pursuanc to this secdon is pcnding or addidonal data on the individual has beea collzcc�d or creaud. The responsibie authoriry shall provide copies of the private or public data upon requcsc by the individua!subjccc of the dara. 'Ihe responsible auchoriry may require the reques:ing person to pay the auual costs of making,cerafying,and compiling the copies. 'Ihe responsibie auchoriry shall co�ply immediatzly,if possible, wich any tzqucst made pursuant to this subdivision,or wichin five days oF the da�e of[ha requast,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc wichin[hac time,he shalt so inform[he individuai,and may have an addidonal Five days within wFuch to comply wit�the request,ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data u not accurate or camplete. An individual may contest the accuracy or compieteness of pubtic orprivate data conceming hir.iself. To exercise chis ri¢:c,an individual shall noa"ry in wriang[he responsible authoriry describing the na[ure of the disagreemeac. The responsible authoriry shall within.i0 days eicher: (a)corrcc the data four.d to be inaccura[e or incompleca and attempt to nodfy past recipiencs of inaccurate or incomplece data, including re:ipien�s named by the individual; or(b)noafy [he individual that he believes[he data to be correcG Data in dispuce shalt be disclosed only if the individual's sc3cemen�of disagreement is included wich the disciosed data. Tha de�erminadon of the responsible au[horiry rn3y be appealed pursuant to the provisions of�he adminiscradve procedure act reladng to conta�td cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri;b.ts of subjects of data", we would like to inform you that your request for a permic or license from the Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: � 1, The informa[ion you furnish wi11 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 ocher local, state or federal a�encies to the excent 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 riahts 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 permi�. Lo� OAU�J /,.��Ui►�t'�C3r/� Firsc bfiddle Lasc �S�oS /4��d9 /�/o Address „/ �—,S�yel S�C� - 90� � �� M C��y Srate Zip Phone � I understand my ri� stated above. ignan:re