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i w Sec.13.04 RIGHTS OF S[JB.TECTS 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 req�red to be given individual. An individual asked to supply private or confidendal data conceming himself shall be informed of: (a)t6e purpose and inrended use of the requesred dara within the collecting§tate agency,political subdivision,or statewide sysum; (b)whether he may refuse oY is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply privau or confidenaal data;and(d)the idenary of other persons or entides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve dara,pursuanc to secdon 13.82,subdivision 5,to a law enfo�ement o�cer. The commissioner of revenue mav nlace the noace rewired under this subdivision in the individual income tax or proaertv tax tefund instrucdons inscead of on rhose forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be infocmed whether he u the subject of stored data on individuals,and wherher it is ctass�ed as public,private or confidenaal. Upon his fucther request,an individuat who is the subject of stored private or pubtic data on individuals shall be shown the dara without any charge w him and;if he desires,shall be informed of the content and meaning of rhat dara. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafur unless a dispute or acdon pursuant to[his secdon is pending or addidonal data-on the individual 6as been collected or created. The responsibie authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the roquest within that tune,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. At►individual may conust the accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall nodfy in writing the responsible authoriry describing che nature of the disagreement. The rosponsible authoriry shall within 30 days either: (a)correct the data found to be inaccu�ate or incomplete and aaempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he betieves the data to be correct: Data in dispute shall be disctosed only if the individuai's statemenc of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to 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 are 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 eztent 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. ��.�v� �/ �-i+/ �/K ��Gt�C 2 rt�1 � 'Fi�� Middle Last . /�.� 7� ^�'i/� �t,�-e �C7 Address �P.�P� � L� v�v tJe ,ru .c� .�s�� 63� �FZo��'� C�n, State Zip Phone. I understand as stated abov .