HomeMy WebLinkAboutDosclosure request form 05/21/01 09:25 FAX 763 559 2202 BA LIESCH Q 002
W-18-2001 04:05pm From-CITY OF ORONO +9622404818 T-076 P.002/002 F-018
OROm ADM=STR=SM OPPICSS .
INPO,RbW:tON DISCGOSM RZQ=ST ,
B33;=SOTA GOVXPMMT DATA PRACTICES ACT
gEQXTESTRR ROTE: •-
A Reeuest Frequency - Private' Data on individuals- After you
have been supplied the data and iafQ=4,d of its me" ng, the
data, need not be disclosed to you for six months thereafter
ur=�.ess -a dispute or action is -pending or additional data 14
you .bas•-beeb. collected.
a. You Keay be rec_uired to pay"aet'ua2 costs is �akixig,
cert.i.fying and/or comyiling the coflies of information
requested. `
Date of Request: .
Requester Name:
AAY az�ss: J3-e-100 �s-�'`` ,4� _ qty,
DIV
Zip:
e Pboae: s/ I Sus3,aess: 76.7 /Y 317
Hum
Description of Ts�o=ation Requested:, r► ,�r� ¢-
Cl q
Rea_'aeste=`.s Siguatvre: Cap
BELOW SNFORMATION TO l' IN BY DONLY
Z Handled By:
Depa=k=ant:
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Request Type= _„_In person , �� Phone
Subject- Of Data Not Subject of Data
gegttesterS
By:
Iaf o=at_an Requested is Classif:.ed: -Z-?tiblic Private
Confidential _ Non-public �Protected Non-Public
P
IS: �Approved
Denied pPproved in_part
Re�.rks/Co�eats: ,
Ant�ori.zea Signature:
� S
Pecs:. ex Page Total Due --
No. a Pages Rate p
05/21/01 09:25 FAX 763 559 2202 BA LIESCH 40001
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You Are Receiving A Facsimile From
Liesch Associates, Inc. ■ 1340015d`Avenue North ■ Minneapolis, Minnesota 55441
Phone: (763) 559-1423 ■ Toll Free: (800) 338-7914 ■ Fax: (763) 559-2202
To: Denise
Company: City of Orono
Facsimile Phone #: 952-249-4616 Date: May 21, 2001
cc:
From: Rod lehn Job Number:
Instructions/Comments: Can I review this file this afternoon? Please call to advise. FYI, I
do have many of the environmental reports generated for this site. -
Transmission Consists of 2 Pages Including This Cover Sheet.
Original to Follow by Mail? ❑ Yes ® No
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