HomeMy WebLinkAboutinfo disclosure request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GO DATA PRACTICES ACT
REQUESTER NOTE - Private Data on individuals. After you
A. Request Frequency
the
have been supplied the data
and ouf foresixfmonthsits ethereafter
data need not be disclosedyou
or additional data -on
unless a dispute or action is p
you has been collected.
be required to pay actual costs in making,
B. You may the copies of information
certifying and/or compiling
requested.
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Date of Requ
est: ►�
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Requester Name:
A.2�
City:
Address:
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zip: SaL�Z>
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Business:
Home Phone:
Description of Information Requested:
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Requester`s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled BY:
Department:
In person
Mail Phone.
Request Type: —
ct of Data
Not Subject of Data
Requested By: Subje
Public _Private
Information Requested is Classified:
_Confidential
Non-Public _=rotected Non-Public
Denied Approved in Part
Request is: Approved —
Remarks/Cc ments:
Authorized Signature:
x Total Due
Fees: es Rate per Page
No. of Pag