HomeMy WebLinkAboutDisclosure Request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE PRACTICES STACT
MINNESOTA GO
REQUESTER NOTE:
A. Request Frequency - Private Data on individuals. After the
ou
have been supplied the data and informed iof x months thereafter
meaning,
h
data need not be disclosed to you
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: 0 3 r
Requester Name:
Address:
UOC7 1. - L 4 -1- GI.. ; foo City: I`nPL<
Zip: S 5210
Business: �la1l5_ y��`3
Home Phone: 1
Description of Information Requested:
lc lik. S-` CPQ a__
. ° 1- - 1-r >
Requester'. s Signature: is - -t' =
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Bequest Type: _____In person
Mail. Phone
Subject. of Data
Not Subject of Data
Requested By:
Information Requested is Classified:
Public _Private
Non-Public Protected Non--
public
Confidential — i n Part
Request is: Approved
Denied Approved __ _
Remarks/Comments:
Authorized Signature: (Z04-4j C--(A.J.^4----.
Fees:. xTotal Due ,
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