HomeMy WebLinkAboutRe: request for info ORONO ADMINIS�p'T�E O�SCES �
=NFpR�SATION DISCLOSIIR� �Q�ST
MINNESaTA � DATp, PR�CTICES ACT
gEQTTESTER N�TE= � on individuals. Af�e= y°u
A, Request Frequency - Private Data
the
have been supplied the data ana" uf foresix montnsethereafter
data need not be disclosed to y
unless a dispute or action is pending or additional data -on
yvu has been coll.ected. zctual costs in making,
g. you may be reauir�d to p�Y
certif ying and%or compi ling t'r.e copies or inf ormation
requested. � �� �� �
Date of Re�uest:
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Requester Name: G���
A.aaress:
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Z�D: SS 3 52S � aG � �
(��--� .3��' Business :
gam,e phone: l f�- �
Description of Information Reauested:
Re�uester` s Si9�nature:
B�OW INgOgMp,T=pN TO BE FII.LED IN BY DEPAR`I^�`I' O�Y
�� -Z Handled BY=
Departme.nt: �.��•
Mai? Phone
r.� persan —
Fte�uest TyPe= " -`-
Not Subject of Data
RecTuested BY: —
Subje�� or Data �_
�_,�;�Z_c _private
Info�ation Requested is Classified=
�ub1;c =rotected Non-PuD1ic
Confidential _Non--
Denied Aporoved in Part
g�ues� is: �ADp roved __
Remarks/Ca�ments:
!
Authori.ze3 Signature: �
� _ $
x Total Due
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