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} ` Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Type of data. The rtghts of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or con£dential data concerntng himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or refusing to suppiy private or con�dential data;and(d)the identity ot other persons or entities authorized by state or federal law to receive the data. This requirement shall nat apply_when an indlvidual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement of�cer. The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or arooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsibie authority,an individual shali be informed whether he is the subJect of stored d"ata on individuals,and whether it is classified as public,private or conCdential. Upon his further request,an individual who is the subject of stored private or public data on individuais shall be shown the data without any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the indiv(dual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the iadividual subject of the data. The responsibie authority may require the requesting person to pay the actual costs of maWng,certifying,and compiling the copies. The responsible authority shall compiy immediately,if possible,with any request made pursuant to this subdivision,or wtthin five days of the date of the request,excluding Saturdays,Sundays and legal i�olidays,if immediate compliance is not possible.If he cannot comply with the request within that time,he shail so inform the individual,and may have an additional Cve days within which to comply with the request,exciuding Saturdays,Sundays and legal holidays. Subd.4. Proccdure when dnta is not accurate or complete. An individual may contest the accuracy or completeness of publicor private data concerning himseif. To exercise this right,an indivtduai shall notify ia writing the responsible authority describing the nature of the disagreement. The responsible authority shall wlthin 30 days eitl�er: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute ahall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority muy be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.5.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will 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 other 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. D��vls 1/� ,��uc C � First Middle Last .�c��" Li��/v� s To iv �� Address (,�r�vz�-�l9- i�1� ��9/ 9�-�71-7� �7 City State Zip Phone I understand my rights as stated above. � ' Si at