HomeMy WebLinkAboutRe: request for info OROliO ADMINISTR.ATNE OFFI�S
II�Tk'ORMATIQi�'. DISCLOSIIRE REQII�ST
MZ�NNESOTA Ga DATA PR.ACTICES �,CT
gE4�ESTLR NOTE: on indivi3ua?s. After you
A, Request Frequen�y - private Data
the
have been supolied the data ar_d uf fo esi�=�on�setheneafter
data need not be disclosed to y
� unless a dispute or ac�ion i.s per�ding or additional data �on
you has been coZ1ected. ��tu� Z �osts in �naking,
B . You may be recuired to paY
certifying and/or corr�piling the copies o= inro�mation
requested• c �
est: �i ,i ti i �i � L
Date of Requ �
• � -
Requester Name: �
2 51-c�� city: ��2o1�L CL
A.ddress- 1 � S �^=/ � tiL s I� /2
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Business -
g�e Phone:
Description of Informati.on I�Zecruested: � � L C��
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Reruestar` s Signature:
BgypW INgOgMATI0�7 TO BE FI�� I� BY DEPARZ'�'-�T ONZ�Y
Ha.�dled By= �' `�d�
Departme�t: �� 2-.
� Mai.� Phone
Request Types �_Tn oe=son
rlot Sub j ect of Data
Sub j ec� o= Dat� �._
Retruested P;y: __
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Tnfo�ation Recaes�ted is Classified: auDlic
�ubl.;c =rotec_ed Non--
Conf�de�tial Nor�--
— �e�ie� Aporoved in Fart
$equest is: A�orove3 —
Remar�s/Co�ents:
Authorize� Signatnre:
= S
x Tota1 Due
Fees: g Rate Pe= Pag� �-
No. of Pa es