HomeMy WebLinkAboutrequest for info (11/89 )
Amount: $ �� ' S � RECEIPT:
Initials �,c✓
REQDEST FOR REPRINT OF OVERSIZED DOCIIMENTS OR
BIIILDING PLANS AND BLUE PRINTS
�1` �
Date of Request: z� �'� �
Name:-���� ��1�'k-i"�.�.-t_,�,�.— Phone: �73"" ��''� 1.�
� • (work)
Addre s s: LS�:'� � � ������Q., �I 1�%`--t--- �'T.�-���Z��
(home)
City: �' ' tf`� C�Cr,•`�(�
State: ��n ✓`� Zip: �� ���
Description of document(s ) to be reprinted: rC�..>�'_ �! �'�
r7� .3I S`� .�-� l�'�� M����c��� ,���
CHARGES: (the following charges are subject to rate changes )
Oversized Documents From Microfilm
The charge for such reprints is $2.50 each.
Building Plans and Blueprints
The charge for such reprints is $0.12 per square foot with
no minimum charge. Reprints will be made at: Engineering Repro
Inc., 13700 lst Ave N, Plymouth, MN 55441. Telephone: 473-2902.
All charges must be paid at the time of the request, and are
non-refundable. Requests will require a minimum of three (3 }
werkir_� �?al�s �o fill, and must be pi�ked up at tre City offi�:es �
unless other arrangements have been made. If prints are
delivered and picked up by courier service, the charge for such
service is to be paid by requestor.
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ORONO ADMINISTRATIVE OFFICBS
INFORMATION DISCLOSDRE REQIIEST
1KINN$SOTA GOVBRI�II�NT DATA PRACTICSS ACT
REQIISSTEIt NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six months thereafter
unless a dispute or action is pending or additional data on
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of Reqnest: Q �� "1 �
Reqnester Name: ��yr�P� ,L.�16 �e,�.-
Address: al�"' ���vtl� ��l70� City:
Zip: ��1�
H�e Phone: y7S '��� � Business:
Description of Information R ested:
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b V1� r���c�.
Reqnester's Signature:
BEIAW INFORMATION BS FILLED IN BY DEPARTl�N'P ONLY
Department: ��Z Handled Bp: �
Request Type: In person �Mail Phone
Requested By: _�Subject of Data Not Subject of Data ,
Information Reqnested is Classified: �Public Private
Confidential Non-Public Protected Non-Public
Reqnest is: �Approved Denied Approved in Part
Remarks/Ca�ments: �i L �-r� p w N E"�
Authoriaed Signatnre:
Fees: x � _ $
No. of Pages Rate per Page Total Due •