HomeMy WebLinkAbout1997 - info discl. 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. �j
Date of Request: ' . v 7
Requester Name: �� ` ?
Address:
U!1070 p-(7 7 7 city: /e9vA5/
Zip: .r-S--- 5 V
Home -
Phone: z/-Z7 r ?2-7. 7 Business: �� - Y6', 6
Description of Information Requested:
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Requester' s Signature41111111916%,K
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BELOW INFORMATION TO BE - - 4• IN BY DEPARTMENT ONLY
----'2_ Handled By: (5•
Department:
Request Type: pe-
In person Mail Phone
Requested By: Subject of Data ONot Subject of Data
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- Not
Information Requested is Classified:
a Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments:
• / 6,e,______
Authorized Signature: v. A
Fees: x $Total Due
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