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r Sec.13.0�3 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as se[forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concernine himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision. or statewide system;(bl whether he may refuse or is leeally required to suppiy the requested data; (c)any known consequence arising from his supplying or refusine to supply pnva[e or confidencial data;and(d)the idenriry of other persons or entities 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�, to a law enforcemen�officer. The commissioner of revenue mav olace the notice required under this subdivision in the individual income tax or orooem�tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be infortned whecher he is the subject of srored data on individuals, and whether it is dassified as public,private or confidential. Upon his further request, an irdividual who is the subject of stored private or public data on individuals shafl be shown the data without any charge to him and, if he desires, shall be informzd of the content and meanin�of that data. 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 thereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible 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 costs of making,certifying,and compiline the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or w irhin five days of the date of the request, excluding Saturdays, Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request within that time, he shall so inform the individual, and may have an additional five days within which to comply with the request, eccludino Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is 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 notify in writing the responsible authority describing the nature of the disaereemznt. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes[he data [o be corrzct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The dererminadon of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relaring ro contes[zd 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 extent 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. C'� L G �� r., �L'� l�� (>2;, First Middle Last c/y S � �/� .�� ,.�t��_ ��— Address.� � � � �� ,,/"'��. --y-{ � C� � �/11 1,' /�j� Cin State Zip Phone I understand my rights as stated above. �� "� �—`---' Si¢namre "---- 6