HomeMy WebLinkAboutrequest for info ORONO ADMrNISTRATIYE �FFICES �
=3�TE'ORMATION DISCLOSIIRE RE4IIEST
. I�iIN�TEgaTp, GO DATA PR�CTICES ACT
' gEQIIESTER NOTE: . -
p,. Request Frequency - Private Data on individuals. Afte� Y°u
have been suppl.ied the data and informed of its meaning, the
data need not be disclosed to you for six months thereafter
unless a dispute or ac�ion is pending or additional data -on
you .has been collected.
B, you may be requirec to pay actual costs in making,
certifying and/or com�iling the copies of information
requested. •
Date of Request: �O` a 3"g9
Requester Name: ���1 -rt � �`'��ln.,,�GiT��V
/�C� !:A?� 5� City: ���)N�/,���(1�
Address: . ,
ZiP: SS 3 � 7
Some Phone:
3(p �- (��p� Business: S/�1��
Description af Iafor�atioa Requeste3: STI2'PP?` F�L�'
�S �
� Requester'.s Signature:
BELOW 2NFORMATION TO BE FII.I�ED N BY DEPARTMENT ONLY
��.,L Han.alea. By: ��.
Department:
In erson Mail Phone.
Request Type= _ � P � — —
g ested B _Subjec� of Data _� Not Subject of Data
� y'
Tn�Formation Reqa
ested is Classified: �_�ublic Private
Confidential Non-?ublic =rotected Non-Public
Denied Approved in Part
Request is: � Approved ,_ --
Remarks/Co�ents:
Authorized Signature: �
_ $
Fess:• x Total Due ..
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