Laserfiche WebLink
ORONO ADMINIST�TSVE OFFICES <br /> INFORMATION DISCLODS���P��I�S ACT <br /> �+iINNESOTA GO <br /> REQIIESTER NOTE: • <br /> p,, Request Frequency - Private Data on individuals. After the <br /> have been supplied the data and inforined of its meaning, <br /> data need notu�e orsaction is pending or aaait onal edatat`on <br /> unless a dzsp . <br /> you has been collected. <br /> g. You may be required to pay actual costs in making, <br /> certif ying and/or compiling the copies oi information <br /> requested. - <br /> Date of Request s �� a <br /> � /-� ��,�,� �' <br /> Requester Name: ��9"��- � <br /> Address: 1 Zo � <br /> L. � City: � �Y�T'-� <br /> Zip: i�����JS`� �/ <br /> Home Phone: <br /> �/�v ' � �� � Business: �"�-r4�'�� G�' � <br /> Description of Information Requested: / <br /> Requester: s Signature: <br /> BELOW INFORMATION TO BE F I.LED IIJ BY DEPARZ'MEr7T ONLY <br /> Q �Z Handled By: �� <br /> Depart�ent: v — <br /> Request Typ <br /> e: p� In person Mail Phone. <br /> gequested By: <br /> Subject of Data �_Not Subject of Data <br /> Inf ormation Requ <br /> este3 is Classifie3: ,�public Private <br /> Noa-Public Frotected Non-Public <br /> Confidential _ <br /> Denied Approved in Part <br /> Request is: �_Approved — <br /> Remarks/Cammentss <br /> Authorized Signatures <br /> _ $ <br /> Fees:� X Total Due <br /> No. of Pages Rate per Page <br />