HomeMy WebLinkAboutInfo disclosure request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GOVERNMYNT 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 yendinQ or addzt onalou for six months edatat-on
actioner
unless `a dispute or is p
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested. �j .
Date of Request: /,// / L�
Requester Name:
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Address: . City: /L.0
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Zip:
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Home Phone: ''� ' L/6/ � d
Description of Tnformation Reuuested: '..__ _1 (
7.
Requester's Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Department:
Z Handled By: V'
Request Type: 0( In person
Mail Phone
Requested By: Subject of Data U�
Not Subject of Data
Tn-Formation Requested is Classified: Pe- Public Private
Confidential
Non-Public Protected Non-Public
QCApproved Denied Approved in__Part
Request is: _ —
Rema rks/Courments:
' / Ai
Authorized Signature: •
= $
Fees:• x Total Due
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