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.� , Sec.13.0-1 RIGHTS OF SUBJECTS OF D:�Ta Subd. 1. Type of data. The ri¢h�s of individual on whom t�a data is sto:�or co be scored shall be as set forth in this secdon. Subd.2. Information reqirired ro be given individual. An izdividual asdc3 to supply privace or confidenaal data concerning himself shall be informed of: (a) �he purpose and in[ended use of the requesced dam w:�in the collecang'state ageacy, polidcal subdivision,or statewide rysum; (b)whecher he may refuse or is legally required�o supply the requesced dan:(c)any l�own consequence arising from his supplying or refusing to supply privace or conndenaal data;and(d)the idendry of other persoas or enanes a�chorized by scate or federal law to receive the data..This requiremeac shall noc apply when an individual is asked to supply investieadve daa, purs�^.�to secaoa 13.82, subdivision 5, to a law enforcemenc o�cer. 'Ihz commissioner of re�enua r-iav place the nodce reauired erd�r[his subdivision in che individual u:come tax or propertv tax refund instructions inscead of on chose forms. Subd.3. Access to data by indi�idual. Upon request to a reswasibie ae�:oriry,an individual shall be informed whether he is the subject of scored data on individuals,and whe�her it is classified as public, priva�or confider.rial. Upon his further reques�an individual who is the subjecc of scored private or public data on individuals shalt be shown che data w•iu.ou[any ch,=e to him and,-if he desires, shall be informed of[he conten� and meaning of[hat data. Aftzr an individual has been shown[he priva::�a�and ic:ormed of ics meaning,the dara need not be disclosed to ti�rn for six mon�hs �}:ereatter unless a dispute or ac6on pursuan�to [his secdon is�:nding or addiaonal data on the individual has been col[ected or creaced. The responsible auchoriry shall provide copies of the private or public da�n�on requ�s:by che individual subject of[he data. The responsible authoriry may require che requesring per5on to pay the actual costs of makin¢,ce^:;ing, ar.d compiling the copies. 'll�e responsible authoriry shall comply immedia�ety, if possib?=.Wi�h any r`quest made pursuant to this subdivision, or within five days of the date of[hz request,excluding Saturdays,Sundays and legal holidays,ii ir..medi2�e compliance is not possible. If he cannot comply with the request wichin tha�dme,he shall so inform the individual,and may have an addi�or.al five days within which to comply with the request,excluding Samrdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. �n individual may contest the accuracy or completeness of public or pri�•ate data conceming himself. To exercise[his rieht,an individual shall noriF�i.�wridng c�responsible authoriry dzscribing che nacure of the disagreemeac. The responsible au�horiry shall wichin 30 days either: (a)correct the dae icund to be inaccurate or incomplece and attemp�to norify past recipiencs of inaccurate or incomplete data, including recipien�s named by rhe individL�l;or(b) codfy the individual thac he bzlieves the data to be coaecc. Data in dispuce shall be disclosed only if ehe individuai's statemenc of disagr:��-nt is i.c:sded with the disclosed data. The de�erminarion of the responsible authoriry may be appzal:d pursuac�to the provisions of che adauniscrarive procedure act relaang to contested cases. DATA PRIV�CY AD�'ISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects oi data' , we would like to inform you that your reauest for a permit or license from the Ciry of Orono or any ot ia deparments may require you to furnish certain privace or confiden[ial information. You are notified that: 1, 'Ihe informacion you furnish will be used to de:ermine�'our qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the pemut or license. 3, The information may be shared with ocher loczl, scate or federal a�encies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become . public. �, You have cenain righcs under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this applicacion or permi�. �-r�%��iv (�lc' E�K' �.G l��i 7� 0� ff First vliddle Lasc Lf'�Ov /'J r� f/�%I'��" ,G/-� _ �aa«55 m� S�E�j `'" �- �� 5��2 y `' �, � o�v � i S �/% __.� City 3tate JZip Phone I understand my ri�hts as stated above. . / � �-��- C Signanire _