HomeMy WebLinkAboutInformation Disclosure Request City of Orono 7,4-07)
Information Disclosure Request
Minnesota Government Data Practices Act 5� e
Completed by que ter
Re�ques r ame( first I): Date of Request: 2
Request Type: ❑ In-Person 0 Mail
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L ,C/7.1 )v J4`r, , u-` 0 Email 0 Fax
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Addiss: n /� /�.2 r�J Phone Numb `O '�e �—U Q ��•.
City,State,Zip Code: `7–�7C Signature•
L�,� L,i.� 141/V57 '3'
Note: MS § 13.05,subd. 12,persons may not be required to identify themselves,state a reason for,or just a - ._- -to gain
access to public government data.A person may be asked to provide certain identifying or clarifying information for the sole
purpose of facilitating access to the data.
Description of the Information Requested: /
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L� � w1S / pl, z �. '� eW � v
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I ha - read t e informatiI ,•-and understand the city may charge fees to provide the information I have requested.
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Signa e
Completed by Department—Office Use Only °-
Department: Processed By:
Method of Response: 0 In-Person 0 Phone 0 Mail Information Classification:
0 Email 0 Fax 0 Public 0 Private 0 Non-Public
❑ Confidential 0 Protected Non-Public
Action: 0 Approved Requested by:
O Approved in Part(Explain below) 0 Subject of Data
O Denied(Explain below) 0 Not Subject of Data
Remarks or basis for denial,include statute section: Identity Verified for Private Information:
❑ Identification(DL, State ID,etc.)
❑ Compare Signature on File
❑ Personal Knowledge
❑ Other
Note: MS§ 13.03,subd.3,authorizes the city to charge fees to recover costs to provide copies of data,including costs
associated with searching,compiling,copying,mailing or otherwise transmitting data. Prepayment is required prior to receiving
copies of data. There is no charge for inspection of data or for separating not public data from public data.
Copy charges: Method of Payment:
❑ (8'/A x 11/14") X 0.25 ❑ Cash
(#of pages) ❑ Check
O (11x17") X 1.00 0 Visa
(#of pages) 0 Master Card
❑ Employee Time($ /hr) X hrs
(only charge if over 100 pages)
❑ Other Charges(attach explanation) Received by:
Total Amount Due: $ Date:
This request will be reviewed by staff and the requester will be provided an estimate of charges prior to copying.
If mailed,return form to: City of Orono,P.O.Box 66,Crystal Bay,MN 55323
City of Orono, 2750 Kelley Parkway, Orono, MN 55356
Phone: 952-249-4600 •Fax: 952-249-4616 • Website: www.ci.orono.mn.us