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