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� / Sec.13.04 RIGFiTS OF SUBJECTS OF DATa Subd. 1. Type of data. The righa of individual on whom[he data is stored or to be swred shall be as sec for[h in this section. Subd.2. InformaGon reqirired to be givea individual. An individuai asked to supply private or conf"idenrial daca concerning himself shall bt informed of: (a)the purpose and intended use of the tequesced data within the collecdag�tace agency,polidcal subdivision,or satewide rystem; (b)whechec he may refuse oT is legally required to supply the requested data:(c)any irnown consequence arising from his supplying or refusing to supply • privace or confidenaal dara;and(d)che idenriry of ocher persoas or enrides auchorized by state or fedecal law to receive the data. This requiremenc shall no�apply when an individual is asked co supply invesrieadve dam,pursuanc to secdon 13.82,subdivision 5, to a law enforcement officer. - The commissioner of revenue mav place che noace rouired und�r this subdivision in the individual income rax or oropem taz refund inscrucrions inscead of on chose focros. Subd. 3. Access to data by individual. Upon request to a respoasible au�horiry,an iadividual shall be informed whether he is the subject of scored dara on individuals,and whecher it is classified as public,private or confidenual. Upon his furcher request,aa individual who is the subjec� of stored private or public daca on individuals shalt be shown che dara wichouc any charge to him and;if he desires,shall be informed of the contenc and meaning of chat data. Aher an individua!has been shown che private dara and informed of ics meaning,the dara need not be disclosed w him for six mon�hs eherea[trr unless a dispuce or acdon pursuanc to chis secaon is pending or addidonal data on the individual has been collected or creaced. 1he tesponsible aurhoriry shall provide copies of[he private or public data upon requesc by[he individual subjecc of che daca. The responsible authoriry may require the requesring person to pay the accual coscs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,wich any request made pursuant to this subdivision,or wi[hin five days of the dace of rhe request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with[he requesc within that time,he shall so infocm the individual,and may have an addidonal five days within wtuch to comply with the request,exctuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private dara cancerning himself. To ezercise this ri¢ht,an individual shall noafy in wridng the responsible authoriry describing the nature of the disagreemenc. The responsible auehoriry shalt within 30 days ei[her: (a)correcc[he dara found to be inaccurace or incomplete and attempt to nodfy pasc recipients of inaccurate or incomplete data,including recipiencs named by the individual; or(b)nodfy the individual that he believes the data to be correct Data in dispuce shall be disclosed only if the individual's stacemen[of disagreement is included with the disclosed dara. The dececminarion of the responsible au[horiry may be appealtd pursuant to the provisions of the adminisQarive procedure act reladng to contesced cases. DATr� PRIVACY ADVISORY In accordance with M.S. 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 Ciry of Orono or any of its departments 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 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 excent necessary to process � the permit or license. 4. If your requested permit or license requ'tres 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. }�J �fl-L� ��n o w� x}- S � � ` ' First Middle Last �50�3 L�.�� J � Address tn.S c�,� 'Z��F 4 �m�. �� 9 I �� l - 0�r '�� Ciry State _ Zip Phone I understand my ri�hts as scated above. � Signamre