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<br /> City of Orono RON�•,
<br /> Information Disclosure Request
<br /> Minnesota Government Data Practices Act `
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<br /> Completed by Requester
<br /> Requester Name(Last First,MI): Date of Request:
<br /> Daniel S. Schleck Aril 11, 2014
<br /> Email:dschleck@hallelandhabicht.com Request Type: ❑ In-Person ® Mail
<br /> ® Email ❑ Fax
<br /> Street Address: Phone Number:
<br /> 33 S 6th Street#3900 612-836-5500
<br /> City,State,Zip Code: Signature:
<br /> Minneapolis, MN 55402 '
<br /> Note: MS§ 13.05,subd. 12,persons may not be required to identify themselves,state a reason for,or justify a request to gain
<br /> access to public government data.A person may be asked to provide certain identifying or clarifying information for the sole
<br /> purpose of facilitating access to the data.
<br /> Description of the Information Requested:
<br /> I am requesting copies of any report, citation, zoning correspondence, emails, study, plan,
<br /> correspondence notes of any kind, meeting notes, meeting minutes, contract, agreement, or any other
<br /> document in electronic or hard copy form from any Councilmember. staff member, employee, third party.
<br /> �t.e consultant, architect, land planner, agent or third party that in refers to, mentions, describes,
<br /> 2jtoo .2*t Wayzata Boulevard in Orono, Minnesota. This request covers the time period from January 1,
<br /> I have read the information on this form and understand the city may charge fees to provide the information I have requested.
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<br /> Signature
<br /> Com leted b De artment—Office Use On
<br /> Department: Processed By:
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<br /> Method of Response: ❑ In-Person ❑ Phone ❑ Mail Information Classification:
<br /> ❑ Email ❑ Fax 0�Public ❑ Private ❑ Non-Public
<br /> ❑ Confidential ❑ Protected Non-Public
<br /> Action: ❑ Approved Requested by:
<br /> ❑ Approved in Part(Explain below) ❑ Subject of Data
<br /> ❑ Denied(Explain below) Not Subject of Data
<br /> Remarks or basis for denial,include statute section: Identity Verified for Private Information:
<br /> ❑ Identification(DL,State ID,etc.)
<br /> ❑ Compare Signature on File
<br /> ❑ Personal Knowledge
<br /> ❑ Other
<br /> Note: MS§ 13.03,subd.3,authorizes the city to charge fees to recover costs to provide copies of data,including costs
<br /> associated with searching,compiling,copying,mailing or otherwise transmitting data. Prepayment is required prior to receiving
<br /> copies of data. There is no charge for inspection of data or for separating not public data from public data.
<br /> Copy charges: Method of Payment:
<br /> (8'/i x 11/14")�5 X 0.25 ICK Cash
<br /> (#of pages) ❑ Check
<br /> Ib(llx17") X 1.00 A 0 0 ❑ Visa
<br /> (#of pages) ❑ Master Card
<br /> ❑ Employee Time($_/hr) X hrs
<br /> (only charge if over 100 pages)
<br /> ❑ Other Charges(attach explanation) R`7
<br /> ed by:
<br /> Total Amount Due: $a A A5 Date:
<br /> This request will be reviewed by staff and the requester will be provided an estimate of charges prior to copying.
<br /> If mailed,return form to: City of Orono,P.O.Box 66,Crystal Bay,MN 55323
<br /> City of Orono, 2750 Kelley Parkway, Orono, MN 55356
<br /> Phone. 952-249-4600 •Fax: 952-249-4616 • Website: www.ci.orono.mn.us
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