HomeMy WebLinkAboutRe: request for info ORONO ADMSNISTR.ATNE 0�=�°S �
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A. gequest Frequency - Private Data on individuaZs. p'�te'� the
ha.ve been supolied the aata and Quf fo esixf Aont:nsethereafter �
data need not be disclosed t� yendina vr additional data -on
-ualess .�a dispute or ac�ion is �p �
you .has been collected.
g. you may be reauirec to pay �actual costs in making,
certifying and/or com�iling the copies or inforraatior_
requested. •
Date of RequeSt= 1 - �" - O�
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Re Name: �� o � ► 1�r� ✓��-� ���
quester
City: �o� �.- �
p�ddress: S� S � ��
zip: 5�33 � .
c�o�9 Business: �'15.2..- y -1 C�- o01 �
Home Phoae: - �IS2..- `-��id� �� �
Description of Inf°�at�'on Retruested.
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Re�raester'. s Signature:
Bg�,OW INFOR��iATION TO BE FIISID IN BY DEPARTMEH� ONLY .
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D epar��t=
Mail Phone
gequest Type� o�In Pe="san . — --
Requested Sy= ____Subjec:. o= Data
�_Not Sui�ject o= Data
p< �unlic _Private
�fo�¢r,ation Requested is Classified: _
Nan-�ublic =rotected Nan-Public
Con=idential —
Denied ABnroved in_Part
ges�uest is. /C Approved — -
Re�arks/Ca��nts:
Anthonzed SignatBre:
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