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Sec.13.04 RIGFiTS OF SLTB,TECTS OF DAT?� ' • Subd. 1. Tyge of data. The rights of individual on whom the daca is srorcd or to be scored shall be as sec forrh in this secaon. Subd.2. Information reqirired to be givea iadividual. An individual asked to supply privace or confideadal dam concerning himself shall be infora::d o,`: (a)che purpose and in�ended use of che requessed dara wichin the eollecang 2am ageacy,golidcal subdivision,o�scamwide ryium: (b)whed:er he may refuse or is_legaily requir.d to supply tbe rquesud data;(c)any laiown coasequence arising from his rupplying or refusing w supply private or connder.Qai data;and(d)the idenary of ocher persoas or earides auchorized by sute or federal law to rrceive che data. 'Ihis requiremeat Shall noc appty when an ir:dividual is asked to supply invesrigadve daa,pursuanc to secdoa 13.82,subdivuion S,to a law enfor�emeat officer. 'Iha ee;-�missioner of revenu: mav pia:e the nodc- rauird und-r this subdivision in the individual income tax or orooem taz refund inscrucdons inscaxd of on chose forms. Subd.3. Access to data by indiridual. Upon requesc to a responsible auchority,an individual shall be informed whather he is che subjecc of stor.d dan on individuals,and whecher it is class�:d as public,private oc conF.dend�l. Upon his furch�r rquesc,an iadividua! who is che subje:c of stoced Qrivace or public dara on individuals shall be shovm the dam wichout any charge to him and;if he desires,shall be informed of the coatenc and meaning of[hat daca. After an individual has been shown the privare dati and informed of ics meaaing,the data ne:d not be disclosed to hun for siz monchs thereafrer unless a dispute or acdon pursuanc co [his secdon is pending or addidooal dara on the individual has been collect�d or ereac�d. Tne responsible authoriry shall provido copies of che priva�or public daca uFon request by che individual subjecc of rhe dara. The responsible autharicy may requir_ [he requesdng Qerson to pay che accual cosu of making,cerdfying,and eompiling the copies. The responsible auchoriry shall comply immediacely, if possible,with any request made pursuanc to this subdivision,or wichin five days of the date of the tequest,ezcluding Sacurdays,Sundays and legal hoiidays,if immediate compliance is not possible. If he cannot compiy with the request wichin that dme,ht shall so inform the individual,and may have an addidooat five days wi[hin which to comply wich the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Ptocedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate dara concerning himsdf. To execcise this right,an individual shall noafy in wridng rhe responsible authoriry dascribing the nature of the disagreemeac. 'Ihe responsible auchoriry shall within 30 days eict:cr: (a)correct tha data found to be inaccurece or incomptete and aaempt to nodfy past recipienes of inaccurace or incomplate data,inciuding cecipiea�s named by cha individual; or(b)noafy the individual thac he believes the daca to be correct Data in dispu�e shalt be disclosed only if the individual's sta�ement of disagreem:nt is included with the disdosed data. The de�erminadon of the responsible au�horiry may be appealed pursuanc to the provisions oF tha adminiscrarive procedure act relacing to con[esud cases. • DAT:� PRIVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "RiJh�s of subjects of data", we would like to inform you that your request for a pernut or license from the Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You aze notified that: 1. The information you furnish will be used to determine your qualif cation 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 wich other local, state or federal agencies to the e�tent 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 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�i'l � � �_�'t Y' iLc-/ r � �� `� G'� /� First �fiddle Lasc /. � %C— �`, � �' C� C c' iL C c'%-c: � %�� _ Address � �_ �/ ,/ cT .,( � �' jG , > � S �.,��i_�.,-� _. � .� !.j �.�. Ciry Sam Zip Ptione I understand my ri;hts as stated above. ,��t` r// [ , ,(�� . �PX.��c �(,��( � i/� i/ Li'��'7�� Signamre