Laserfiche WebLink
ORONO ADMINISTRATIVE OFFIC$S <br /> INFORMATION DISCLOSDRE REQIIEST <br /> MINNESOTA GOVERNMSNT DATA PRACTICES ACT <br /> REQDSSTER NOTS: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data on <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Reqnest: % � ���� y/ <br /> Requester Name: � i <br /> Address: ��6� (o� i'�v�e. City: <br /> Zip: ��3j � <br /> Ho�e Phone: �/�� — �� �l�- Business: <br /> Description of Information Requested: <br /> Requester's Siqnature: �--- "7�� ^ <br /> BffiAW IPFORMATION TO 8$ FILLED IN BY D TIKSNT ONI�Y <br /> Department: Handled By: <br /> Request Type: In person Mail Phone <br /> Requested By: Subject of Data Not Subject of Data , <br /> Information Reqnested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Reqnest is: Approned Denied Approved in Part <br /> Reaarks/Ca�ments: <br /> Authoriaed Signature: <br /> Fees: x = $ <br /> No. of Pages Rate per Page Total Due � <br />