HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRIITIVE OFFICES
INFORMATION DISCLOSIIRE RE4DEST
MINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE:
A, Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data nea distute orsaction is pending or add tional edatat�on
unless P .
you has been collected.
g, yQu may be required to pay actual costs in making,
certif ying and/or compiling the copies oz inrormation
requested.
Date of Request:
� ��
' ����� /� �/'
Requester Name: ,.,
' � � � _
� � �Z - City: <2�:
Address:
Zip: s'�� y �
Home Phone: /����"/�5�C��� Business :
Description of Information Requested:
/'�� G" ��
' s Si ature: �'� �'���
Re�uester �
BELOW INFORMATION TO BE FI ED IN BY DEPARTMENT ONLY
!�£� Handled By: CI —
Department s ��
Request Typ
e: � In person Mai1 Phone
R ested B Subject oz Data � Not Subject of Data
equ y:
ublic P
Information Requeste� is Classified: � � Privat_
Confidential Non-?ublic =rotected Non-Public
Request is: D�' Approved
Denied Approved in Part
Rp�arks/Comments:
Authorized Sigaature:
� �-�`-`'`�`'--�
_ $
Fees: X Total Due
No. of Pages Rate per Page ..