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� � Sec.13.04 RIGHTS OF SUBJECTS OF D�T,� Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as sec forth in this secdon. Subd.2. Information required to be�ven indicidual. ?.n individual asked to sugply private or confidenrial dara concerning himself shall be in2ormed of: (a) the purpose and incended use of the requestEd dara wi[hin the collecting'state aeency, polidcal subdivision,or statewide sys[em; (b)whecher he may refuse or is legally required to supply che requested dara;(c)any k�own consequence arising from his supplying or refusing to supply priva[e or confidennal data:and(d)the idendty of other persons or entides authorized by state or fedetal law to receive the data. This requirement shall no[apply when an individual is asked to supply invesoeanve data, pursuan[to secaon 13.82, subdivision�, to a law enforcement officer. The commissioner of revenue mav olac ch nonc auired ❑nder this subdivision in the individual income taz or vropertv taz refund instructions instead of on[hose forms. Subd. 3. ?,ccess to data by individual. lioon request to a responsible au[honry,an individual shall be informed whe[her he is the subject oT stored data on individuals, and whe[her i[is ctassitied�s public, pnva[e or confidennal. Upon his further request, an individual who is the subject of srored privare or public data on individuals shall be shown che daca wi[hout any charge to him and, ii he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown che private data and iiuormed of its meaning, the data need not be disclosed ro hun for six months[hereatter unless a dispuce or acdon pursuanc[o this secnon is pending or addidoaal data on[he individual has been collecced or crea[ed. The responsible au[horiry shall provide copies of the prna[e or pubiic data upon request by rhe individual subject ot the data. The responsible authoriry may require the requesting person ro pay the actual costs of makine, cemfyine, and compiling che copies. The responsible authoriry shall compiy immediaceiy, if possible, with any request made pursuant to this subdivision, or wi[hin five days of the date of[he reques�,excluding Saturdays.Sundays and legal holidays, if immedia[e compliance is not possibfe. If he canno[comply with the request wi[hin[hat time,he shall so inform the individua(,and may have an additional five days within which to compty wi[h[he request,excluding Sa[urdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleceness of public or private data concerning himself. To exercise this rieht,an individual shall nocify in wndng the responsible au[horiry describing the na[ure of the disagreement. The responsible au[hori[y shall within 30 days eicher. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, includine recipiencs named by [he individual; or(b) nodfy the individual cha[he believes the data to be correct. Data in dispute shall be disciosed only if the individual's sta[Pmen[of disagreement is included with the disclosed data. The derermina[ion of the resoonsible au[hori[y may be appealed pursuanc ro the provisions of the adaunistranve procedure act rela[ing [o con[ested cases. DATa PRIVACY ADVISORY In accordance with Iv1.S. 13.04, Subd. 2, "Rights of subjects oT data", we would like to inform you that your request for a permit or license from �he Ciry of Orono or any of its depanments may require you to furnish certain private or confidential iniormation. 'r'ou are .oti*ied that: 1, The information you furnish will be used to detemune��our 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 ocher local, state or federal aQencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Councii action to approve, some information may become public. 5. You have certain rights under ti1.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. �'��, , � ��•:rrt� �° �`�.�'� �r s, F�rst �fiddle �SL � r� 1 �e r r � fl � �' 1�� . Address � , - C�-, � r; � �f S�'-, � �� l,i _ .'y - ? C � _ �� , Ciry State Zip Phone I understand my rights as sta[ed above. � 1' j�. �C` / \';.��',�z:. Signamre