Laserfiche WebLink
ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSIIRE REQDEST <br /> MINNESOTA GOVERNr+�ENT DATA PRACTICES ACT <br /> REQDESTER NOTE: <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 vf information <br /> requested. <br /> Date of Request: " { � `f ` `� � <br /> C .._ � : <br /> Requester Name: �� � � � ��' � �'�`" <br /> ' �`�; ��z City: I'_,: _ w�,y� C-:������ <br /> A(�dre$$: �9�\�C l_ �w� y l�:.; _�.\ <br /> Zip: �a �� �3 � <br /> Home Phone: Business: 3 � 3 - � / j % <br /> Description of Information Requested: ��'�, � 5 � � � �����-'t �-�����``"'�- <br /> � <br /> 1 � � �// � 5 ��. f . <br /> � N� � � S �• .c// �y �G?�:t>'!'1wC �f�1�2'.4�'t:.'i <'c.�-'�<� hd C!1 i6� �rNU� i .� <br /> � <br /> Requester' s Signature: / - _ ��.L�--� <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMLNT ONLY <br /> Department: Handled By: <br /> Request Type: In person Mail Phone <br /> Requested By: Subject of Data Not Subject of Data <br /> Information Requested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> Remarks/Ca�ents: <br /> Authorized Signature: <br /> Fees: x - $ <br /> No, of Pages Rate per Page Total Due <br />