HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
I FORMATION DISCLOSURE REQUEST
IIINISESOTA G40V=u4uKNT DATA PRACTICES ACT
REQUESTER NOTE:
A. Requesou
t Frequency - Private Data on individuals. After aningr the
have been supplied the data and informed
uf fo esixf months its ethereafter
data need not be disclosed to You
fOor additional data -on
unless a dispute or action is pending
you has been collected. actual costs in making,
B . You may be required to Pay the copies of information
certifying and/or compiling
requested.
Date of Request:
� c e 4 �u
Requester
Name:
City: -
Address: `� G
Zip
Business:
Home Phone: °/
Description of Information Rec
ested:
Requester' s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department
in DerSOn Mail —
Phone
Request Type= —
Not Subject of Data
Subjec- of Data
Requested By:
Public Private
Information Requested is Classified=
_
Non-Publicted Non-Public
-rotec
_Confidential —
Bequest is: Approved
Denied Approved in Fart
Remarks/Cents:
Authorized Signature:
x Total Due
Fees: g Rate per Page
No. of Pa es