HomeMy WebLinkAboutRe: request for info ,� 3 ��s.
ORONO ADM.INISTRATIVE OFFSCES �
INFORMATION DISCLOSIIRE REQIIEST /
MINNESOTA Ga DATA PR�CTICES ACT
' REQIIESTER NOTE:
A. Request Frequency - Private Data on individual.s. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six montns thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g. You may be reguired to pay actual costs in making,
certifying and/or compiling the copies oi information
requested. '
�
Date of Request: � � � ''
Requester Name: ����'
Address: �,3�C7 G- � City: �G[\�*� i
i
ziP: �'�J3�� j
gome Phone: ���''�"_ 3 Business:
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Description of Information Re�uested:
� �
�..5 -u2 .L'`�I�-�c
Requester'. s Signature:
BELOW INFORMATION ED IN BY DEPART�NT ONLY '
�t2 $analea By: .c�
Department-
Request Type:
p� In person Mai1 Phone
g�qiaested By' Subjec� of Data � Not Subject of Data �
. � ;
Information Re�qnested is Classified:
� �ublic Private I
Confidential Non-�ublic �rotected Non-Public
ge�uest is: _�Approved Denied Approved in Part
Remarks/Com�ments:
Authorized Signature:
_ $
Fees:- x Total Due
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