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Sec.13.04 RIGH'TS OF SUg.fEC'fS OF D.�T?► Subd. i. Type of data. The righcs of individual on whom che data is s�oced or ro be stored shall be as sec forth ia this secrion. Subd.2. Informatioa reqirired to be giren indiridual. An individual uked w supply private or coafidendal dara cancaning himself shall be informed of: (a)rhe purpose and imm�ded use of ehe requested data wirhin the coUecaag Stace agency.polidcal subdivision,or srstewide rystem; (b)wheeher he may refuse oY is legally«quired to supply rhe requesced data:(c)any Imown coasequeace arising from his supplying or cefusing to supply priva[e or confidendal data;and(d)the identiry of o�her persoas or enddes authotized by scace or federal law ro receive the dara. 'Ihis requirement shall not apply when an individual is uked to supply invesdgarive dara,pursuanc ro secaoa 13.82,subdivision 5,to a law enfoceement officer. 'Ihe commissioner of revenue mav olace the nodce rewired under rhis subdivision in the individual income tax or propem tax refund instnuaons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a cesponsible authoriry,an individual shall be informed whether he is che subject of stored dara on individuats,and whe�her it is classified as public,private or confidendai. Upon his further request,an iadividual who is the subjecc of stored private or public data on individuals shall be shown che dara wirhout any charge to him and;if he desires,shall be infocmed of the coatent and meaniag of that data. After an individual has been shown che private data and informed of ics meaning,the data need not be disclosed w him for six monrhs thereaher unless a d'upute or acdon pursuant to ehis secrion is pending or addiaonal dara on[he iadividua!has been collected or creared. The responsible authoriry shall pmvide copies of ehe privace or public daca upon request by the individual subjecc oF the daa. 'Ihe responsible authoriry may require rhe requesdng person to pay the actual coscs of making,certifying,and compiling the copies. The responsible auehoriry shalt comply immediately,if possible,wich any request made pursuant to this subdivision,or wichin five days of • the date of the requesc,excluding Sacurdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply wi[h tbe request wichici that time,he shall so inform the individuai,and may have an addiaoaal five days within which to comply with ehe request,excluding Saturdays, Sundays and legat holidays. Subd.4. Procedure when data ts not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in wridng che responsible aurhority describing the nature of the disagreemeat. The cesponsible au[horiry shall wiehin 30 days either: (a)comect the data found to be inaccurdte or incomplece and atumpc to nodfy past recipients of inaccurace or incompiete data,including recipien[s named by�he individual;or(b)noafy the individual that he believes[he dara to be correcc. Data in dispute shall be disclosed only if che individual's stacement of disagreement is included wirh the disclosed data. The decerminaaon of the responsible auchoriry may be appealed pursuanc w the provisions of the adminisaarive procedure act relating to contesud cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rishts of subjects of daca", 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 furnish certain private or confidential information. You aze notified that: 1. The information you furnish will be used to detecmine 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 ocher local, state or federal a�encies to the extent necessary to process the permi[ or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain righcs 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 pecmi�. i�i(',�� r�� l S 1�ca R o�' First ,�/ �tiddle Lasc �C/'S(7 /UUU'�� s�o�� Aaanu ��v�� V�f ��3L� �ia��7/- �3 ��3 Ciry Sta�e Ztp Phone I understand my riQhts as stated above. / � Signatura "