Laserfiche WebLink
ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQUESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, the <br /> data need not be disclosed to you for six months ending or add tionaledatat-on <br /> er <br /> unless a dispute or action is p <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. q c <br /> Date of Request: l o <br /> Requester Name: � , <br /> Address: 0.-09 <br /> E,..+C.8-\ C cr2 2.tL �C - City: (,3 C <br /> Zip: s(3 �t1 <br /> Home Phone: 413 --? 170 Business: <br /> Description of Information Requested: S L <br /> i <br /> Requester' s Signature: ,:r----7.--7-.) i 4.101C <br /> BELOW INFORMATI TO BE FILLED IN BY DEPARTMENT ONLY <br /> �c. Handled By: <br /> Department: <br /> _Z1L_______ <br /> Request Type: <br /> 01-In person Mail Phone <br /> Requested By: Subjectof Data DC, Not Subject of Data <br /> Information Requested is Classified: <br /> 04- Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Request is: p .. Approved _Denied Approved in Part <br /> Remarks/Comments: <br /> / (cLicy..em.s.. <br /> ed Signature: <br /> Au-thora.zA ', <br /> Fees: xTotal Due <br /> No. of Pages Rate per Page <br />