HomeMy WebLinkAboutRe: request for info ,_ � � ;'�
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� C/�J — OR02i0 ADMSIISS�RATSYE ��=�S •
� =NF'OR2dATION DISGLDS��PR�I�S gCT
• - I�iII�TNESOTA GO ,
• ggQpES�ER NO�E: .
" • After yau
p�. gearuest Frequenc� - Private� Data oa individuals. the
have been supplied �e osea ta a uf fa esixf mcntnse hereafter •
data ne�d not be aiscl. Y
• � . .unless 'a dispute or ac�ion is �pending or additional data -on
� � you .has� been. collectea. .
You may be reauired to pay�'actual �cos�s in �akinc;
B. the covies of information
certifying aad/ar compiling
requested. •
Date cf Reqaes-t s
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Reqaester Name: •
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p,,ddress:
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�01 -��2�' Business:
H�e Phones G� � ��� � � •
Description of Informatioa Reauested:. �5
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� gequester'.s Si,gnature:
BgyOW =NgORMATION TO BE FII.I+ED IN BY DEPARZ'MEIdT ONLY
$an.dle3 sY=
Depar��'�=
MaiZ Phone
gequest Type= In person . — --
gequested Sy= —Subjec:. o= Data
Not Subjec� oi Data
?uDlic Private
�ozmation Requeste3 is Classified: __
=rotected Non-Public
Con=idential Noa-?ublic .
� Denied ' Anproved in_Pat.
ge�ruest is: _ Approved — � �
Re�arks/Coaiments s .
Anthori.zed Signature: -
_ $
Pees:• X Tvtal Due ,
Na. of Pages Rate pe= Page .
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