Laserfiche WebLink
ORONO ADMSN=S�RAT=VE �F�=�S • <br /> 1�`TFORMAT=ON DISCLOSIIRE RESZ�ST . <br /> • • �S�NESaTA Gp DATA PR�CTICES ACT . <br /> • ggQUESTSK NO�E: • <br /> � • • Af ter you <br /> A, geauest Ereque�cy - Private� Data on individuals. the <br /> hati-e been supplied the data and uf fa�Si°f mantnse herea�ter � <br /> data ae�d aot be discl.osed t� yendinc or additional data -on <br /> . � . .unless :a di5pute or ac�ion is -p . .. . . . <br /> � � you .has� been collectec. . ' � <br /> you may be reauired to 'pay"a�tual cos�s in �aking; <br /> B' and/or compiling the copies o� in=orrsatio� <br /> certif ying <br /> requested. �//�� D • <br /> � � , <br /> Date cf Request- <br /> , . <br /> , <br /> Req�ester Name s ����� <br /> . �,� , City: <br /> Address: v ` <br /> � Zip= � <br /> H�e Phane s <br /> Busiaess: <br /> Descr <br /> 'oa f o , atiaa R _ ested:. <br /> ' Reqaes�er'. s Si.,gnature: <br /> BgyOW �7'pORMATION TO BE FII.LID IN BY DEPARTI�HT ONZ'Y <br /> Handled By: <br /> Depart��t= <br /> Mail. Phone <br /> gequest Type= In person _ — <br /> geques�ed By= Subjec� of Data <br /> Nat Sub�ect of Data <br /> ?ui�lic Private <br /> 7nfarmat.�.on Reqaested is Classified= — <br /> No�-?ublic __=rotected Noa-Public <br /> Conf idential . • <br /> Denied � Anproved in_Pat <br /> gecaest is: ,_ Aoproved — --- ' . � <br /> Rem.arks/Caamtents- . <br /> . � G,/ JC ...� � � ,r....v. <br /> Anthorize3 Signature: ��;�rr - $ � <br /> Pees:- x Tctal Due „ <br /> No. af Pages Rat= per Page . <br /> - ; <br />