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Sea 13.G1 RIGHTS OF SLfBJECTS OF D:�T.� Subd. 1. Tvpe of data. The ri¢hts of individual on whom�e dara is stor�or to be scored shall be as sec for[h in this secdon. Subd.2. Iaformation req�red to be given individual. An ir.dividuai askcd to supply privare or confidendal dara concecning himself shall be informed of: (a)the purpose and imm�ded use of the ctquosred data wi�in the collccring�tate agency,potidcal subdivisioa,or statewide system; (b)whee2ter he may refuse oi is legally requued co supply the tequested data;(c)any Imown coauquence arising from his supplying or refusing to supply privace or conndential daca;and(d)the idendry of other persoas or enuaes xechorized by sute or federal law to receive the da�a..'Ihis requiremenc shall not apply whan an individual is asked to supply invesdgaave data,pursu�c to secdoa 13.82,subd'►vision 5,to a law enforcemenc officer. The commissioner of re�•enuo mav vlace the noace teauircd erd�r[his subdivision in the individual income_tax or vropem taz refund inscructions instead of on those forms. Subd.3. Access to data by indi�idual. Upon request to a�ssponsible a�choriry,an individual shall be inforwed wherher he i�the subject of scored data on individuals,and wheeher it u classified as public,priva`or confidenrial. Upon his funher mquest,an individual who is the subject of scored private or public data on individuals shall be shown the daa wi�:out any c"narge to him and:if he dasires,shall be informed of the concent and meaning of rha[data. Afrer an individual has been shown ehe privar:dan and ia:ormed of�cs�►�aain8.the data need not be disclosed to him for six monchs eheceaiter unless a dispute or acdon pursuanc co this secrion is cending or addidonal data on the individual has been coltecced or created. The responsible auchoriry shall provide copies of the priva�e or public da�a cron requ�:by che individual subject of[he data. The responsible au[horiry may require[he requesring peaon to pay the acmal cosct of making,ce;�:.ying,and compiling the copies. 11te responsible authoriry shall comply immediacely,if possibie,with any request made punuant to this subdivision,or within five days of the daco of[he requesc,exeiuding Saturdays,Sundays and legal holidays,if imcnedia�e compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addiconal five days wichin w6ich to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or eomplete. An indiviGual may contesc the accuracy or compieteness of public or private da[a concerning tiunseif. To exercise�his right,an individual shall nodfy ia writing cac responsible authority describing che nacure of the disagreemenc. The responsible auchoriry shall wichin 30 days either. (a)correct the dac�fcund to be inaccurate or incomplece and attempc to nodfy past ncipienrs of inaccurate or incomplete dara,including recipien[s named by the individLJ;or(b)codfy the individual thac he believos the data W be correcc. Data in dispuce shsll be disclosed otily if the indiviaual's statement of disagrr_�enc is i.clndtd with the disclosed daea. The decerminarion of[he responsible authoriry may be appealcd pursuacc w the provisions of the administrarive procedure act retadng to contes[ed cases. . DATA PRIV�CY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri¢hts of subjects ot data", we would like to inform you that your reauest for a pemuc or license from the City of Orono or any of ia depar�ments may require you to fumish certain private or confidential information. You are notified that: 1, The information you fumish will be used to de:ermine�•our qualification for the perm.it 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 agencies 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. �. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (, Your full name is required to process this application or permic. D Walock First Vliddlt Last 12360 River Ridge Boulevard Address • -- � 55337 952-894-9882 Ciry Stace Zip Phone I understand my riDhts as stated above. _ Signacure