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, Sec.13.04 RIGHTS OF SLlBJECTS OF DAT?i Subd. 1. Type of data. 'Ihe righcs of individual on whom[he data is scored or to be scored shall be as set fonh in this secdon. Subd.2. InformaCon reqirired to be given individual. An individual asked to supply private or confidenual dara conceming himsetf shall be informed of: (a)the purpose and inrended use of the requested data wi[hin the collecdng�tate agency, polidcal subdivision,or sratewide rystem; (b)whecher he may rofuse oY is legally required co supply[he requested data;(c)any lrnown consequence arising from his supplying or refusing to supply • privace or confidenriai daa;and(d)the idendry of other peaoas or enrides auchorized by stace or federsl law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesdeadve data,pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. - The commissioner of re�•enue mav place the noace reauired under this subdivision in the individual income tax or oropem tax refund instrucdans inscead of on chose forms. Subd.3. Access to data by individual. Upon requesc w a responsible authoriry,an individual shall be informed whether he is the subject of stored dara on individuals,and whe[her it is classified as public,private oc confidential. Upon his furcher request,an individual who is the subject of stored private or public data on individuais shal!be shown che daca wichout any charge to him and;if he desires, shall be informed of the content and meaning of that data. ARer an individual has been shown che privace dara and informed of iu meaning,[he data need not be disclosed to hitn for six monchs[hereaher unless a dispute or action pursuanc to chis secdon is pending or addidooal data oa the individual has been collected or creared. The responsible authoriry shall provide copies of the private or public data upon request by rhe individual subjecc of ehe dara. The responsible authoriry may require the requesring person to pay the accual cosu of mafcing,cerafying,and compiling the copies. The responsible authoriry shall comply immediacely,if possible, wich any request made pursuant to this subdivision,or wi�hin five days of the dace of che tequest,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot camply with rhe requesc wirhin thac time,he shalt so inform che individual,and may have an addiaonal five days within which to comply wich the requesc,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accurscy or completeness of public or private dara concerning himself. To exercise ehis ri¢hc,an individual shali noafy in wricing the respoasibte auehoriry describing the nacure of the disagreemenc. The responsible auchoriry shall within 30 days eicher: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipiena named by che individual;or(b)nodfy the individual thac he believes che data to be cocrect. Data in d'upute shall be disclosed only if the individual's statement of disagreoment is included with the disclosed data. The determinarion of the responsible au[horiry may be appealad pursuant to the provisions of[he administradve procedure act reladag to conrested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data",we would like to inform you tha[your request for a permit or license from the City of Orono or any of its deparcments 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 qualification for the permit or license requested. 2. You may refuse co 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 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 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 permit. �.�,,/ �. /�.s� First �fiddle Last y2a E l�rcE`5� Address ZZ� , ��.�z�-�- �.✓ sr3g� y�3 -z Ci�, State Z�p Phone I understand my rights tated above. E;� / � Signature ;� ' i.