Laserfiche WebLink
ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISL�OSURE RE4UEST <br /> MINNESOTA GO DATA PR�CTICES ACT <br /> ' gEQIIESTER NOTE= <br /> A, Reqnest Freauency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, the <br /> data need nat be disclosed to you f or six montns thereafter <br /> unless a dispute or ac�ion is pending or additional data -on <br /> yvu has been collected. <br /> B , you may be required to pay actual costs in making, <br /> certifying and/or com�iling the copies oi inr"ormation <br /> requested. <br /> Date of Request: �3 <br /> . � _. <br /> Requester Name: ' <br /> Address: �1��� •�1 � CitY: <br /> z�P: S�35/�" <br /> Home Phone• y��/-=�.��o Business: �74- `JG44 <br /> Description of Information Re�quested: _ 4 <br /> . � <br /> - r <br /> Requester'. s Signature: <br /> BELOW INFORMATION TO BE FII,.LED I� BY DEPART�?NT ONZY <br /> Handled By: <br /> Department- <br /> Request Typ <br /> e: In person Mai1. Phone <br /> g ested B Subjec� oz Data Not Subject of Data <br /> e�u Y= <br /> Inf ormation Re�qu <br /> ested is Classified: �ublic Private <br /> Confidential Non-�ublic =rotected Non-Public <br /> Request is: <br /> Approved Denied Approved in Part <br /> Remarks/Co�ents: <br /> ,> :. <br /> '';�,_� ��__-��``��- <br /> � <br /> Authorized Signature: <br /> � � _ $ <br /> Fees:� x Total Due <br /> rio, of Pages Rate per Page :- <br />