Laserfiche WebLink
ORONO ADMSNISTRATIVE OFFICES <br /> INFORM�TION DISCLOSURE RE4IIEST <br /> MSNNESOTA GaVERI�NT DATA PR�CTICES ACT <br /> ' gLQIIESTER NOTE: . <br /> A, Request Freauency - 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 oi in=ormation <br /> requested. � <br /> Date of Request: � 1 1�'f' I �� <br /> Requester Name: C 4 � '�J�V�'� <br /> Address: � �� �-A' <br /> 1Gk S T L-J � City: („)►'4r!2�'9'.T ►�. <br /> zip: S �� Gl , .-� �.. 2,� 2� <br /> Home Phone: `"� � � S �� � Business: � � � <br /> Description of Information Res3uested: � ��^ <br /> - G��t c���� P'=�� �- ��- ���. cJ�J rn.��r�� <br /> � � �'�G=':x''_, L_r�Ffcc� I�c�-����� /td <br /> �. � <br /> Requester' s Signature: '^ <br /> BELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT ONLY <br /> ��2- Handled Bys d' <br /> Department: — <br /> In erson MaiZ Phone <br /> Request Type: �_ P <br /> g ested B Subjec� of Data �_Nvt Subject oi Data <br /> �u �'' � <br /> Inf ormation Rer�n <br /> ested is Classified: � �ublic Private <br /> Confidential Non-�ublic =rotected Non-Public <br /> Approved Denied Approved in _Part <br /> ges�uest i s: _�, <br /> Remarks/Comments- <br /> Authorized Signature: <br /> _ $ <br /> Fees:� x Total Due <br /> No, of Pages Rate per Page •• <br />