HomeMy WebLinkAboutInfo Disclosure Request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCILOSURE REQUEST
MINNESOTA GOVERNMENT DATA PRACTICES ACT
REQUESTER NOTE: ou
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning,
datalneedanodispute
peorsclosed to you for six months action is pending or additional thereafter
at-on
unless a
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: li 161q1
Requester Name: lias 6t41 iq 0 Lc, Lr of
7 n �_tv City: ,- �� u
Address:
Zip: ) ) �' S 1, p /
Home Phone: 7 �l1
41 3 i Business: Z ri e r Tecc_ i 't- i
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Description of Information Requested: `t 7‘ C lAri '.t.1 i trt.(Jk Pd ic! L
Requester's Signature: j4/1-4(,*- /CI-6-U) C'.% d
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Request Type:
In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Information Requested is Classified:
Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Camments:
Authorized Signature:
Fees: x Total Due
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