HomeMy WebLinkAboutInfo. Discl. Request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GOVERNMENT DATA PRACTICES ACT
REQIIES'lEX 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: - ( 2 - c-t?
Requester Name: ( u- sJ -ti' 6 L-`'`'"t) w r f
�- L ov 4A/Lez
Address: ' 610 C
City: 1,. H � >> l- t 12_t .--
��
Zip: '7( I G /
Home Phone: 66ct - (25 ( Business: 5 5 ( 7 z7(-f
Description of Information Requested:
—to L
Requester's Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Request Type:
In person Mail Phone
Requested By: Subject of Data Not Subject of Data
equ t`
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
P
Request is:
Auproved Denied Approved in Part
Remarks/Comments:
'1&40
It/
Authorized Signature: � C /
/
Fees:- x $Total Due
No. of Pages Rate per Page
ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST "
• MINNESOTA GO DATA PRACTICES ACT ,
• REQUESTER NOTE=
A. Request Frequency - Private Data on individuals. After you
he
have been supplied the data and of for
.unless
monthsits ethereafter "
data need not be disclosedyending or additional data -on
.unless .`a dispute or action is -p
you .has been collected.
You may be required to pay "actual costs in making,
certifying
B. and/or compiling the copies of information
requested.
Date of Request:
0
Air-4I
et Name: Ce�I
Request /
,,oll, .. S�c,e' `' i �i - City: a
Address: ,,I,
Zip: -C7 3�( / .-�5-_ ,-�
j 3 3 Business
Home Phone:
Description of Information Requested:
i .
I"- �I �; ce,i �- .
Ar7 r r' -'-^---_,
gequester'. s Signature: ,�s .Aii&
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
n Handled By: !�
Department: U��2
Mail _=hone
Request Type: of In person " —
Subject of Data vc Not Subject of Data
Requested By: — t`
information Requested is Classified:
pt Public Private
Non-Public
Protected Non-Public
Confidential. — � ;n Part
Request is: Approved
Denied Approved __
Remarks/Comments:
Authorized Signature: -
Fees: xTotal Due
No. of Pages Rate per Page