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. , Sec.13.04 RIGHTS OF SUBJECPS 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 secdon Subd.2. InformaHon reqwTred to be given indivldual. An i�ividual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requesred data within t�►e collecting state agency.political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any l�own consequence arising from 6is supplying or refiising to supply.private or confidemial data;a�(d)the ide�ity of other persons or e�ides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82, subdivision 5,to a law enforcement officer. Th�commissioner of revernie mav olace the notice rewired under this subdivision in the individual income tax or nm�rCv�x refinid inc�mctions instead of on those forms. Subd.3, Acceas to data by individval. Upon cequest to a responsible authority,an individual shall be iaformed whether he is the subject of swced data on individuals,and whedier it is classified as public,private or confidential. Upon his further request,an individual who is the subject of soored priva�or public data on individuals shall be shown the dara widiout any charge w him and,if he desires,shall be informed of the content and meaaing of that data. After an individual has been shown the private data a�l informed of its meaning,the data need not be disclosed to him for six mo�s thereafoer untess a dispute or action pursuairt to this sec6on is pe�ing or addidonal data on the individual has been collected or cceated. The respons�le aud�ority shall provide copies of the privatie or public data u�n request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual wsts of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,wid►any request made pursvant to this sabdivision,or within 6ve days of die date of the request,excluding Sadirdays,Sundays and legal holidays,if immediate compliaQce is noc possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidoffiI five days within wluch to comply with the request, excluding Saturdays,Sundays and legal holidays. Subd.4. Pra�edure when data is not accurate or complete. An individual may con�st the accuracy or completeness of public or private darn com;erning himself. To exercise this right,an individual shall notify in writing the responsible authority descrihing the aature of the disagreement. The respons�le authority shall within 30 days either. (a)corr�t the data fauod to be inaccuia�e or inwmplete and attempt to notify past recipiems of inaccuiate or incomplete data,includ'mg recipients named by the individual;or(b)notify the i�lividual that he believes the data to be correct Data in dispute shall be disclosed only if the individual's statemeat of disagreement is included with the disclosed data. The determiaation of the responsffile 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�ity 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 shared with other lacal, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested�rmit or license requires Council action to approve, some informarion 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. �R i� �t-tve�.. �-a,P�`Z� g� Middle `-/33a �ok.-{-t, �1,02� �rL,✓.� Aaa�� 5.3�� l02—�7�—�'7�6 �2on� Ciry State Zip Phone I understand my ri as stated above. Sig�aue 6