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Sec,13,04 RIGIiTS OF SUBJ'6CTS OF DATA <br /> Subd. I. T}�pa of dai�. Thc righta of individu3!oo whom the data is scoted or co bc srnrad shail be as sec fonh in ihis:eedon. <br /> Subd.2. Informot(on required to bc pvea tndiridcial. An individuz!asked to supply pr�vsce vr cu�ifidendal dan conaeming himaeif ihait <br /> be informod of: (a)the purpose and ineended use of tha rtqutscod dnta within the collecring Etatn agency,polidcal subdi�ision,or sutewroe rysmm: <br /> (b)wheeher he may rtfuse or ia lcgally required�o supply the rcquesu:d data;(c)any known tonsoquencc arising from his svpplying or rtfusing to supply <br /> prn�ace or confidenrial dau:and(d)ehe idenriry uf o�her persons or enaties au�horizcd by ctitc or federal law to tecei�e the data, This requiremenc shall <br /> nol apply when an individual Ie askcd�o supply inYoacigari�e aau,pursu�ni co secuon 1).82, subdivision 5, w a law cnk�rcemene officer. <br /> The eommissioner of revenus mav �lace tht eptice reauircd under th's�sut+ai�i�ion fn fhe indi�iJ al incomo eax or omeertv tai refund <br /> In6rtvcriorts mstoad of on�hose forms, <br /> Subd.3. Aceeas to dat9 by indJvt�lual, Upon request to a rzaponsible 1ulltoriry,an tf�dividual sliall be intotmcd Whether he ia the subjett <br /> af smred daca on individuals,and whceher it is ct�ssified as public,pri�uc or cortfideneial. Upon hir funher request, an individual Who it the subject <br /> of stored pti�ate oi public dats on individuals shall be shown the dara wiihou(any cl�arge to liim and, if he desires, shal!be ittformed of ehe contcnt <br /> and meaning of ehac da�a, After an individual has bccn shoe+n the privaco dau xnd informcd of iu maning,che dnsa need no[be disclosed to him for <br /> siz months thcroatter unless a dispuce or action pursuant to[his section is pending or addiuona!dau on the ind;vidual haa been cullected or creatcd. <br /> 'fhe responrible authority shall provide copies af ihc priva�e or Dublic dan upon requese by ehc indivldual subjcct of�he dan. 7'he cesponsible au�horiry <br /> may rzquire the reques�ng person to pay�hc acroal coses uf niaking, certifying, and compiling Ne copiea. <br /> The respoosible au[horiry s}ial!comply immedia�e(y,if possible, wieh any requesc made pursuant to�1,is subdi�ision,or wichin tvc days of <br /> ihe dac�of�he requesc,excluding S�tutdays.Sundays nnd legat holidays.if immcdia�e compli�nce is noc possible. If he cannoc comply wich the requcac <br /> wiehiA that time,he s1�a11 so ii�form ehe individual,and may havc an ndd'ltianal�ve dayi u�j(hin whicll fo comply with the cequcst,excluding Snturdays. <br /> Sundays aM legal holidays. <br /> Subd,4. Protedtite�hen data i,no(accurate oT eomplete. An inGi�idual itiay concese Uw accurncy o�completeness of public or pr{vate <br /> dad concerning h;mself. 7o exereisc�his righc,an individual ahall nocify in wriring�hc rosponsible auihuriry describing�he nature of tT►e disagreemene. <br /> The responsible authoriry shall Within 30 days eicl�er: (a)correcc�he daca fnund to be inaccvrate or incomplete aod saempt to aoufy pas�rscipieuts of <br /> inaccura�e or incomple[c dau, tnNuding rtic;picnu named by�he individu�l:or(b)norify ehe individual d�ar he believes�he data co be corrcce. Daca <br /> in dispute shalt be discloacd oNy if ihe Individu�('s sta�ement of disagreetnenc is includcd with the discloscd data. <br /> Tl�e dctcrmina[ion of clte responsible authoriry may be appcaled purstlant to th�provisions of the administtatiLc procedure ac:[rel�cing to <br /> concesced caaes. <br /> AATA PI2.IVACY ADvISORY <br /> 1n accordance with M.S. 13.04, Subd.2, "Rights of subjeccs vf dsta", wc would likc to inform you�ha�your request <br /> for a permit or liCense from the City of Orono or any of its deparcmcncs may require you to furnish certain private or <br /> confidcntial information. <br /> Yov are notified tha,t: <br /> 1. The information you furnish will be used to determine your qualitic�[ion for clie pernut or liccnsc requested. <br /> Z You may refusc to supply data, but retiisal may require thac the Cicy deny the pernzit or licensa. <br /> 3. 'Ihe information may be shared with other locaJ, state or federal agencies to thc excent nccessary to process <br /> the permit or liccnse. <br /> 4. If your requesced petmit or license requires Council ac�iutl to approvc, suine informacion may become <br /> public. <br /> 5. You have cercain ri�hts uader M.S. 13.04 (available upon requcst) to revicw privatc data on yourself. <br /> 6. Your 11i11 namc is rCqUired t� process this application or pecmit, <br /> ' a <br /> Fitsc Middlc �s� <br /> , _ , . ` ,^ �, <br /> Address , , `, �-� ' �. <br /> Ci(y , - Sute Zip Phone -� <br /> I understand my righcs ns stated above. <br /> � � <br /> , J <br /> �' � �� � f ' <br /> 5ignaNte <br />