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� . Sec.13.04 RIGHTS OF SIJB.TECTS OF DaTA Subd. 1. Type of data. Thc righcs of individual on whom the data is stored or co be stDred shall be as set forth ia this secdon. Subd.2. Information reqirired to be given individual. An individual azked to supply privace or confidendal dara concerning himself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecang�tace agency,polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply[he requested data:(c)any known wasequence arising from his supplying or refusing to supply private or confidential dara;and(d)the idendry of other persoas or enades authorized by state or federdI law to receive the data. This requirement shall not appty when an individual is asked to supply invesngadve dam, pursuant to secdon 13.83, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the noace rwired under�his subdivision in the individuai income tax or orooem az refund instrucdons ins�ead of on�hose forms. Subd.3. Access to data by individual. Upon requat to a respoasible authority,an individual shall be informed whether he is the subject � of stored dara on individuals,and whether it is classified as public,priva�e or confidenaal. Upon his further request,aa individual who is the subjecc of stored private or public data on individuals shall be shown the dara wichout any charge to him and;if he desires,shall be informed of the content and meaning of that data. Aher an individual has been shown che priva�e daca and informed of irs meaning,the dara need not be disclosed to him for six monrhs thereafrer unless a dispuu or acdon purSuant to rhis secdon is pendiag or addiaonal dara on the individual has been collect�d or creared. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible autfioriry may require the requesdng person to pay the actual costs of making,cerrifying,and compiling the copies. The responsible authoriry shall compiy irnmediately, if possible,with any request made pursuant to this subdivision,or wichin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addirional five days within which to comply wi[h the request,excluding Saniniays, Sundays and legal hotidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accurdcy or comple[eness of public orprivate data concerning himself. To exercise chis righ[,an individual shall nodfy in wridn;the responsible au[horiry describing the nacure of the disagreemenc The responsible au�hority shall within 30 days either: (a)correcc the data found co be inaccu�ate or incomplete and atumpt to nodfy past recipientt of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)notify the individual that he believes the dara to be correct Data in dispute shall be disclosed only if[he individual's stacement of disagreement is included with[he disciosed data. The determinadon of the responsible authority may be appealed pursuanc to the provisions of the admirust:adve 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 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 deternvne your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3. The information may be shared with ocher local, state or federal a;encies to the extent necessary to process the permi[ or license. 4. If your requested permit or license requires Council action to approve, some information 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 applicat' n or permit. - � ,�J � �,�, ��;� '� �-� Ck-�-��'� � g(n� � ! Middle I.ast , — " �f1 , �_7�_. � �i C� . Address ,�n • / n �,� 'Y �'� ►� �� J -'-`> ��' < L. . Ciry 3tate Zip Phone I underst my rights as stated abov � �, Signam e j ; ( _ _