HomeMy WebLinkAboutInfo. Disclosure Request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GOVERNMENT DATA PRACTICES ACT
REQUESTER NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six months thereafter
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:
/44-1
��i ter/,
Requester Name: /
c��o'/2
Address: > o y:
Zip: . � 1
7/ _ 5'O �/ Business: �C� --s-3'S�
Home Phone: --�
Descr' tion of Information Requested: �,
TIP
Requester' s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Department: Handled By:
person Type:
In Mail Phone
Requested By: Subject of Data Not Subject of Data
Pqu
Information Requested is Classified:
Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature:
Fees: x $Total Due
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