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� � ?.. Sec.13.04 RIGHTS OF SUBJECTS OF D�T� Subd. 1. Type of daca. Tha righcs of individual on whom[h�data is srored or to be scored shall be as se�forth in this secdon. Subd.2. Information reqirired to be�ven indiridual. An iadividual asked to supply privace or confidzorial dara concerning himseif shall bz informed of: (a)che purpose and inrended use of the requcsced dara wichin che collecting"sta�agency, poliacal subdivisioa,or scacewide rysum; (b)whether he may refuse or is legally requir.d co supply the r.quested data:(c)any Imown coasequence arising from his supplying or refusing to supply private or conndendal daca;and(d)che idendry of orher parsoas or enanes aurhocized by s�ate or federal law to r�ceive th=data. This requirement shall not apply when an individual is asked to supply invesdgadve daca, pursuanc to secaon 13.82, subdivision 5, co a law enforcemenc ofricec - Tht commissioner of revenue mav olace ch� noace r_ouired und�r this subdivision in the individual incone tax or orooem tax refund insrructians inscz�d oF on�hose forms. Subd. 3. Access to data by indi�idual. lipon request[o a responsible au�horiry,an individual shall be inforred whether he is the subject of s�or.d data on individuals,and whether it is classified as pubiic, priva�e or confedenoal. Upon his furcher request, aa individual who is the subjecc of scored privace or public dan on individuais shali be shown the dara wichouc any charge to him and,'if he desires, shall be informed of che contenc and meaning of�hat data. After an individual has bzen shown the priva�:data and informed of ics meaning,che data need not be disclosed to him for six mon�hs chereatter uriless a dispute or acdon pursuanc to this secrion is pending or addidonal data on the individual has been collzcced or created. Tha responsible auchoriry shall providz copies of the privace or public data upon requesc by the individual subjecc of[he dara. The responsible authoriry may require che requesring per5on to pay the actual costs of making, cerrifying,and compiling the copies. The responsible authoriry shall comply immedia�ely,if possible, wich any request mada pursuant to this subdivision, or wi�hin five days of the dace of the requcst,ezcluding Sacurdays,Sundays and legal holidays,if immediace compliance is noc possible. If he caanot comply with the requesc wichin[hat time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the requesc,exctuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compieceness of public or pri�•ate data conceming himselF. To exercise chis riehc,an individua!shali noa"ry in wriang che responsible auchoriry describing che nacure of the disagreemeac. The responsible auchoriry shall within 30 days either: (a)correcc che data found to be inaccurate or incomp(ece and attempt to nodfy pasc recipients of inaccurace or incomple�e data, inciuding recipien�s named by che individual;or(b)nocify the individual thac he believes �he data to be coaect. Data in dispuce shalt be disclosed only if che individual's staczmenc of disagreemenc is included with che disclosed data. The de�erminarion of the rzsponsibte auchoriry may be appealzd pursuant to the provisions of the adminiscrarive procedure act reladng 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 pernuc or license from the Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You are no[ified 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 tha[ the City deny the perm.it or license. 3. The information may be shared wich ocher local, state or federal ageacies to the extent necessary to process the permit or license. 4. If your requested permit or license requ'tres Council action to approve, some information may become public. 5. You have cenain ri�hts 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 perm.it. �� y l� �� '� - First �tiddle Last �(f�� '��/1 �, � L �/.� 5 l — Address 5"l� �o�rs �9� << /�'/�0 s"s"`fz�> ��):.,U -o7� J Ciry State Zip Phane I understand my ri;hts stated a�v� �� � ' - �� Signacure