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� , . Sea13.04 RIGFiTS OF S[18JECTS OF DaTA ' Subd. i. Type o[data. 'Ihe righcs of individuai on whom the data is scoced or to be stored shall be u sec focch in this section. Subd.2. In[ormation required to be pvw indiridual. An iadividual uked w suppiy private o�confidendal daa conceraing himself shali be infocmed o(: (a)the purpose aad iatended use oE che requared dara wichia the collecang Ytate agenry,poGdcai subdivision.or satewide rystem: (b)whethen c�tnay reft�se oti is.legally tequited to supply che ctquesud data:(c)aay lmown coasequence arising from his supplying or refuswg w supply privace or confidendal data;and(d)che idendry of ocher persoas o�earides au�horized by snce orlederal law m ceceive che dara. This iequiremeac shall not appty when an individual is uked to supply iavesdgadve dam,pursuanc ro secdoa 13.82,subdivisioa S,w a taw enfac�emeat officer. The commissioner of revenu-mav vlaca the nodc- reauired under dtis subdiv�ision in the individual income tax or orooem taa refund insccucaons inscead o!on rhose forms. Subd.3. Access to data br individual. Upon request to a responsible aurhoriqr„an individual shall be informed whether he is che subjecc of swced dan on individuals,and whecher it is classified u public,private or confidenaal. Upon his tt�riher reQuesc,aa individual who is�he subjecc of saoced private o�pubtic daa on individuals shall be shown che dara wichout any charge to him and;if he desires,shall be informed of the content and meaning o[that data. Afte�an individual has been shown the privare daca and inforaud ot iu meaniag,the data need noc be d'uclosed oo hicn for six moadu thereaher unless a dispute o�acaon pursuant w this secdon is pending or addidonal data on the individual has beea collected or croared. The tesponsible au�horiry shall pcovide copies of the privare o�public dara upon cequest by the iadividual subjecc of rhe daa. The responsible suthociry may nquire[he raquesdng person to pay the actual cosu of makin$,cerdfying,and compiling che copia. The cesponsible suthoriry shall comply immediately,if possible,wich any cequest made putsuant w this subdivision,or wirhin five days of the dace of the nquesc,excluding Satucdays,Sundays and legal holidays,if immediace comQliance is not possible. If he canaot comply with die requesc within that dme,he shatl w inform the individual,and may have an addidonal five days within which to comply wich the request,excluding Saturdays, Surtdays uid legat holidays. Subd.4. Ptocedure whea data ts not aceurate or complete. An individuat may contest the accuraey or completeness of pubtic or private dan concerning liimsetf. To exercise chis right,an individua!shall noafy in wriring dte respoagibte authoriry describing the nature o[die disagreemenG 'I�e responsible authoriry shall within 30 days eithe�: (a)correcc rhe data fouad to be inaccurdte o�incomplete and atumpc to nodfy past mipients of inaccurace or incomplece data,including cecipien�t named by ehe individual;or(b)noafy the individual that he believes che data to be correcG Data in dispuce shall be disclosed only if the individual's statement of disagreement is included wirh the d'uclosed data. The determinadon of the responsibie au�horiry may be appealed puauanc to the provisions of the adminisaarive procedure act telaang to contesud cases. • DATA PRIVACY ADVISORY In accordance with M.S. 13.04�Subd.2, "Rights of subjecu 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 furaish certain private or coafidencial information. You aze notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. '��ou may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3. �'he information may be shazed wich ocher local, stace or federal agencies to the excenc 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. A.� � V� o w.� 1^ l ►" First �fiddle 1�� [ 200 L � �'' ST Aaa� �c� v�-� �`v� o S S�12 �S S 3 -v C�� q �iiy Snce Zip Phoae I understand my rights as stated above. r---- ------� Signature