HomeMy WebLinkAboutRe: request for info ORONO ADMINISTR�iTIVE OFFICES
INFORM�TION DISCI�OSIIRE REQIIEST
MINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTEs .
A, Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning,
the
data need notu�e orsacti n is pend ng or aaa t onal edatat�on
unless a disp .
you has been collected.
B. y o u m a y b e r e q u i red to pa y actual costs in making,
certif ying and/or compiling the copies of in f o r m a t i o n
requested. -
Date of Request s � �� 6
Requester Name: ��'�' ��(
Address: I (U v W��-��'''�� �0 City: �iP�d
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Home Phone: �U�� ��� �/ Busines s:
Description of Iaformation Requ
ested: C�nI S�R�c-��� `� V�i�'dCF
{-h Sr�,2 F �RuPc� � ��1 H �� S .ww�
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Re�uester: s Signature:
BELOW INFORMATION TO BE FII�LED IN BY DEPARTM�NT ONLY
Handled By: '
Depart�ent: d a Z -
Request Type=
_In person MaiZ Phone
gequested By:
Subject of Data _�_Not Subject of Data
Information Requested is Classified:
o< Public Private
Confidential Non-�ublic _�==otected Non-Public
Denied Approved in Part
Reqnest is: � Approved _
Remarks/Comments-
Authorized Signature: �
_ $
Fees:� x Total Due
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