HomeMy WebLinkAboutrequest for info ORONO ADMSNIS��TI� �FF=�S
rI�7E'ORMATION DISCLOSIIRE RE4IIEST
HINNESOTA Ga DATA PR�CTICES ACT
' gEQIIESTLR 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 coll.ected.
B. you may be reauired to pay actual costs in makinq,
certif ying and%or compiling the copies oi insormation
requested. �
Date of Request:
, � � ^� ����' -�---
Requester Name= c' e
p y: 1�,� c� Ll L �``��1
Address: �. (�' ! � � � c� S��- cit
z�P- ��� � � �
Business- � ��c `� � �' -� �
gome Phone: ,�
� ested: � U� � G� i �1 � � �P� w► i , 5
Description of Information Kequ
��c�C� l �� .
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Requestes`. s Signature:
C � �
BELOW INFORMATION TO BE FILLID IId BY DEPARTMENT ONLY
Handled By:
Department=
Request Type: _In person
Mail Phone
Subjec� o= Data Not Subject of Data
geqzaested By: `
Inf ormation Requ
ested is Classified: ?ublic _Private
Confidential Non-�ublic =rotected Non-Publi.c
gequest is:
Aporoved Denied Aaproved in_Part
Remarks/Camments:
Authorized Siguat�re:
_ $
Fees:� X Total Due
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