HomeMy WebLinkAboutRe: request for info ORONO ADMINIS2'RP,TSVE OFFI�S
INFORMATION DISCLOSIIRE RE4IIEST
2r4INNESOTA GO DATA PR�CTICES ACT
' gEQUESTER NOTE:
�. Request Frequency - Private Data on individua?s. After you
have been supplied the data and informed of its meaning,
the
data needdistute orsaction is pendi q or add ti n 1 edatat-on
unless a p
you has been col.Iected.
g. You may be requirec to pay actual costs in making,
certifying and/or comailing the copies oi information
requested. � • '
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Date of Request:
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Requester Name: ' ,
Address:
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Description of Information Re�uested: � I
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Requester' s Signature:
gELOW INFORMATION TO BE FII.LED IN BY DEPARTMENT ONLY
t. �� i �� � �;��-�`,L, � � �,s� Handled By:
Departmen 'i
�� In erson Mail. Phone
Request Type= P
R ested B Subjec� of Data �� Not Subject of Data
es�'u Y' `
Information Re�u
ested is Classified: �/ �ublic Private
Confidential Non-�ublic =rotected Non-Public
gequest is: �_Approved Denied Approved in Part
Remarks/C�ents:
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Authorized Signature: -" `��'�
_ $
Fees:� X Total Due
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