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� : � Sec.13.04 RIGIiTS OF SLTB,TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the dara is stored or to be stored shall be as set forth in this section. Subd.2. Information reqirired to be given iadividual. An individual uked W supply private or confidendal dara concemiag himself shall be informed of: (a)the purpose and intended use of the cequested data within the collecang State agenty,political subdivision,or stauwide rystem; (b)whether he may refuse oY is kgaily requiced to supply the requesud dara;(c�any knowa wnsequence arising from his supplying or refusing to supply privaoe or coafidential data;and(d)the idenary of other persoas or endaes authorized by state or federal law to receive the data. This requirement:shall not apply when an individual is asked to supply invadgadve dara,pursuant to secdoa 13.82,subdivision 5,to a law eaforcemen.t o�cer. The commissioner of revenue mav place che noace required under ehis subdivision in the individual income tax or erovem tax refund instcucdons instead of on those forms. Subd.3. Access to data by individual. Upon request to a cesponsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is class�ed as public,private or confidenaal. Upon his turther request,an individual who is the subject of stored private or public data on iadividuals shall be shown the data withouc any charge to him and:if he desires,shall be informed of the concent and tneaning of that data. After an individual has been shown c6e private data and informed of its mcaning,the data need not be disclosed to him for siz months thereafur unless a dispute or acaon pursuant to�his xcaon is pending or additional dara on the individual has been collecud or cnated. The respocuible suthoriry shall provide copies of the private or public data upon request by die individual subject of the data. The responsible authority may require the requesting person to pay the actual coscs of making,cerdfying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant w this subdivision,or wi[hin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with the request within that time,he shall so inform the individual,and may have an addiuonal five days within which w comply with the request,exciuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completen�ss of pubiic or private data concerning himself. To exercise this right,an individua!shall norify in writing the nspoasible authoriry describing the nature of the disagreement The cesponsible authoriry shall within 30 days eithe�: (a)correct the data found m be inaccurate or incomplete and aaempt to nodfy past recipienu of inaccutate 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 shall be discloud only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appeaied pursuant ro the provisions of the adminis�aave procedure act relating w contesud cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Ri,,ahts 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 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 to supply data, but refusal may require that the Ciry deny the permit or license. 3. The inform�tion may be shazed 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. iar� �� J//��/1�ef�!/ iadle �t ��f�� '�i e s�n u,�" �n, ��- Ad ss ` �� /��7Q �// �� or �a �P �v�, i� � � Ciry State Z�p Phone I understand my rights as stated ve. , Signaare