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{ 3 Sec.13.04 RIGFiTS OF S[TBJECTS OF DAT?� ' Subd. 1. Type of data. The righ�s of individual on whom thc data is s�ored or to be scored shall be as sec foczh ia this secdon. Subd.2. Intormation reqirired to be given individual. An individual asked to supply private ot confidenrial dara concccning himself shall be informcd of: (a)the purpose aad intended use of the requuud dara wichia the coUecang Ytatn agency,poliacal subdivision,or smcewide rysum; (b)whecFen c�may refuse or is.legaily requir.d to supply che requesud data;(c)aay laiown coasequence arising from his supplying or rcfusing to supply private or conndendal data;and(d)[he idenriry of ocher pec�oas or enddcs au�horized by sc�te or federal law to receive the data. This rcquitemcnt shall not apply when an individual is asked to supply invesdgadve dara,pursuan[to secrion 13.82,subdivision S, w a law enforcemenc officer. The eerimissioner of revenu- mav pIa^- the nodc- rauired under chis svbdivision in the individual income caz or oropem taz refund inscrucdons inscaad of on chose forms. Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whtther he is the subjecc of stor.d daca on individuals,and whecher it is classified as public,privace or confidendal. Upon his further request, an individual who is the subjecc of stored Qrivate or public dara on individuals shall be shown�he data wi�hout any charge to him and;if he desires,shall be informed of the contenc and meaning of[hat data. Afcer an individual his been shown che private data and informed of ics meaning,the data need not be disclosed to him for six monciu thereaher unless a dispute or acdon pursuan�to �his secdon is pending oc addidonal da�a on the individual has been collecced or created. The responsible authoriry shall provide copies of the privace or public data uQon request by the individual subjecc of[he data. Thz responsible authoriry may requice [he requesring person to pay�he accual cosu oi making,cerdfying,and compiling the copies. The cesponsible auchoriry shall comply immediacaly, if possible, with aay requesc made Qursuanc to this subdivision,or wi[hin five days of the dace of the request,excluding Sanirdays,Sundays and legal hotidays,if immediace compliance is not possibte. If he cannot comply with the rsquest wi[hin that dme,he shall so inform rhe individual,and may have an addidoaal five days within which to comply wich the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Ptocedure when data is not accurate or complete. An individual may concest the accurdcy or complaeness of public or privace dara conceming himself. To exercise[his right,an individuai shail norify in wridng the responsible aurhoriry describing the naare of the disagreement. The responsible auchoriry shall wichin 30 days ei[t:er: (a)correcc che data found to be inaccurate or incomplete and aaempt to nodfy past recipiencs of inaccurate or incomp(ece data, inciuding recipien�s named by[he individual;or(b)nodfy the individual thac he believes the data to be correct. Data in dispuce shall be disclosed only if[he individual's statemenc of disagreement is included wi[h the disclosed data. The determinadon of the responsible auchoriry may be appealed pursuanc to the provisions of tha adminisaarive procedure act relaang to conmsud cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts 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 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 local, state or federal a;encies to the ectent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some informa[ion may become public. 5. You have certain 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 permit. j�.;��,��I`z L 1�'Y.� ,J� �:%n�' Firsc�— �Sid e Lasc �t��.��- �f - Addcess . --� � — - n ',�,,� �, � S ��. c� Y/f ��< ��-' . ��y�-v� �i'► - Ciry Sct�e Zip Phone I understand my ri;hts as stated above. �---�� 1�' slgnacure --`