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� f: , . _. , Sec.13.04 RIGATS OF SUBJECTS OF DATA � Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given indtvidual. An individual asked w supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting State agency,political subdivision,or statewide system; (b)whether he may refuse or islegally required to supply the requested data;(c)any lmown coasequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigadye data,pursuant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the nodce reauired under this subdivision in the individual income t� or uropertv taz refund instcuctions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject � of sWred data on individuals,and whether it is class�ed as public,private or confidendal. Upon his further request,an individual who is the subject of swred private or pubflc data on individuals shall be shown the dara without any charge to him and,if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for su months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individua(subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible suthority shall comply unmediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five days within which W comply with the request,excluding Saturdays, Sundays and legal holidays. , Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or complereness of public or private da�concerning himself. To ezercise this right,an individual shall notify in writing the responsible authority describing the nawre of the disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating w contested cases. DATA 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 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 City deny the permit or license. 3. The information 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. ��o+u � 1� ��1'Z--- Fusc � � ��N1i� � Lasc Add ss r _ '� _� J� r ��1� � /� ��'1 ��yTGI r�/ � ) City State Zip Phone I understand my ' s as stated ab ve. Signawro