HomeMy WebLinkAboutre: request for info ¢0 City of Orono FOR CITY USE ONLY
C \ 0 P.O.Box 66
14's" 2750 Kelley Parkway Date Received: Time:
h ' Crystal Bay,MN 55323
(952)249 4600
REQUEST FOR PROPERTY INFORMATION
Internal, City Use Only
Property Information:
Type: residential ❑ Commercial
Address: � ''1✓
Requestor:
Name: V
Company(if applicable):
Address:
City: Zip:
Home Phone: Alternate Phone:
Questions regarding the above noted prope�hya-nW Nf, W 0 /r�ty: l/�
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v:\chris mattson\request for property information form.doc
Last Updated: August 28,2007
ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GoVMUU4ENT 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 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:
ZLI
Requester Name:
7city:
Ql�
Address: 2
zip: 3s�
2 Business:
Home Phone: 7
Description of Information Requested:
Requester`. s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
D ep artme-nt:
Request Type= person erson Mail Phone.
Requested B Subject of Data Not Subject of Data
� y:
Information Requested is Classified: Public _Private
Confidential Non-public -rotected Nan-Public
Request is:
Approved Denied Approved in Part
Remarks/comments:
Authorized Signature:
Fees: x Total Due
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