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seo.t3.oa tucFrrs oF sus.rEcrs oF nara ' Subd. 1. Type o[data. The righcs of individual oa whom che data is scoced or m be sccred shall be u sec focth in this section. Subd.2. Intormation nqtrired to be prm indiridw�l. An iadividual uked to supply private or confidendal dara coacerniag himsdf shall be informed of: (a)the pucpose and iateaded use of the requested dara withia the colleccng State agency.po(idca!subdivision,or statewide rysum; (b)whetkec he taay tefuu ot is,legally c�equind to supply the cequesud data:(c)any lasown caauquence uisiag from his supplying or ret�su►g w supp[y privace o�confidendat data;and(d)the idendry o!ocher peaoas or enddes auchorized by snce or fedenl law m receive t6e data. This requiremenc shalt noc apply when an individual is uked to supply invesdgadve daa,pursuaat ro secdon 13.82.subdivision 5,w a law enfoccemenc office�. The eec*�missioner of rcvenue mav olac- che nodc- rwired under this subdivision in the individual income cax oc orooertv ax refund instrucdons iascexd of on chose focros. Subd.3. Aecas to data by individual. Upon request to a responsible authodry,an,individual shall be informed whether he is ehe subject of sceced dara on iadividuals.and whecher it is classified u public,privace or confidendal. Upon his funher request,aa individual who is die subjecc of stored privace or public dara on iadividuals ahall be shown the dara wirhout any charge to him and;if he desires,shall be infocmed of the content and meaning of that data. Afur an individual has been shown�he private dara and infocmed of iu meaning.the daa need not be disclosed o0 6im for six months thereafur unless a dispute or acaon Qunvanc to this secdon is pending or addidonal daa on the individual has been coUecced or creared. The responsible authoriry shali provide copies ol the private or public dara upon cequest by the individual subject of the dan. The responsible authociry may cequire the cequesdng person to pay the actual cosu of makiag,cectiiying,and compiling the copiu. The responsible au[horiry shall compiy immediacety,if possible,wirh aay cequesc made pursuant co this subdivision,oc wichin five days of the date of the request.excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot compty with the requesc wict►in that cme,he shall so inform the individuat,and may have an addidonal five days within which ro comply wi�h the request,exduding Satucdays, Sundays and legal holidays. Sabd.4, Ptocedure when data is not accurate or complete. An individual may contest the accuracy or completeneu of public or priva[e dara conceming himself. To exereise�his right,an individuai shall noafy in wridng che tespoasible aurhoriry describing the natuce of the disagreement. The respoasible authoriry shall within 30 days eicher: (a)cortect the data faund ro be inaccurdce or incomptete and atumpt to norify past cecipieetcs of inaccunte o�incomple[e data,including recipiena named by�he individual;or(b)aoaf�the individual that he believes the data to be cotrecc. Data in dispute shall be disclosed only if the individual's statemenc of disagreemenc is included with the disclosed data. The determinadon of the responsible authoriry may be appealed puauant ro the provisions of tha adminisaarive ptocedure act relating to contesad cases. • DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Rishcs of subjeccs of data",we would like to inform you that your requesc for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidencial information. You aze notified that: 1. The information you furnish will be used to determine your qualificadon for the perm.it or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3. ,.; •:. ;Fh�i,�€prmatioa�m�}c be.shared with other local, state or federal agencies to the eicent necessary to process , t thr perm�t or liEens�.'.� �' ' '4. •' If�y6t�f r�quested perm.it or license requires Council action to approve, some information may become public. •�, ��- 5. You have certain rights 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�. Fitst Middle lasc Addcess . Ciry State Zip Phone „ , -' . � �• .':�'� . � .t � �. I understanfl my ri�ts as stated above. - _ .. .,. : ; ' Signature _ . , , � , `.�,� , . . . . ,.' - _•� . {