HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORIKATION DISCLOSIIRE REQDSST
MINNESOTA GOVER1�II�iT DATA PRACTIGES ACT
REQIISSTER 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 Request: ��/Zs/�//
Reqnester Name: T�o»��-s , �.v�-�
�ddress: /57�,� �'����r v✓�-�� �� . City: ST . �l�. �
Zip: �� .3c� �
Ho�e Phone: ��Z "��� 'G'��� Bnsiness: �
Description of Information Requested: � �e ���� � �yZ� �f /�• �
Reqnester's Signature: � u�-� c;c.�- �
BffiAW INFORI�lATION Tb B8 FILLED BY DEPARTl98NT ONLY
Department: Handled By:
Request Type: In person Mail Phone
Reqnested 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
Re�arks/Cc�ments:
Authoriaed Signatnre:
Fees: x = $
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