HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GoVMUVJENT DATA PRACTICES ACT
REQUESTER NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need dispute oractionis pending or additional sed to YOU for six months thereafter
at-on
unless a disp ,
you has been collected.
B. You may be required to pay actual costs in maiming,
certifying and/or compiling the copies of information
requested.
Date of Request:
l
Requester Name: J
dress: c Z®-o (Dr !�•� City:
Ad �'-n ��"'��'�
zip: Fj cS sZ
Home Phone: L-173- 7"
Business: ?3
Description of Information Requested:
t,
Requester I.. s Signature:
BELOW INFORMATION TOILLED IN BY DEPARTMENT ONLY
r Handled By: �C�•
Department: �� � �-
aC` In person Mail Phone
Request Type:
Requested B Subject of Data C�!- Not Subject of Data
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Request is: O- Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature:
Fees: x Total Due
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