HomeMy WebLinkAboutrequest for property info ORONO ADMINISTRATIVE OFFICES
INFORMATION DIS�LOSIIRE RE4IIEST
2SINNESOTA Ga DATA PRACTICES ACT
RE4IIESTER NOTE=
A, Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need notube orsaction is pending or add tional edatat�on
unless a disp .
you has been collected.
g, You may be required to pay actual costs in making,
certif ying and/or compiling the copies or iniormation
requested.
, j -, %�
Date of Request: � �
. � �
Requester Name- ;��� '� ' f� ., `"
Address:
_ � ��i� i ' " C �� �� City: � � ( ���.� � ,
Zip: `� �- -
, ?
gome Phone:
- � - � ����- Business : � /� _ , r .�' _�
. ested: �`��� �� ` " ��" /����
Descrzption of Information 8e�u
G �� _ - `� �
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Re�uester' s Signature: � �--`
BELOW INFORMATION TO BE FII,LED IN BY DEPART�NT ONLY
Handled By: - "' �_` -
Departstent: ��� Z ,�
� In erson Mai1 Phvne
gequest Type: P
R ested B Subject of Data J� Not Subject of Data
� y:
Information Requested is Classified:
i'��ublic Private
Confidential
Non-?ubli� =rotected Nan-Public
ge�uest is: �
Approved Denied Approved in Part
gemarks/Camments-
�
Authorized Sigaature: `"---
'. _ $
Fe�s: x Total Due
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