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HomeMy WebLinkAboutInformation Disclosure Request VA ~City of OronoNp Information Disclosure Request Minnesota Government Data Practices Act s� S"k BHOPQ Completed by Requester Requester Name(Last First,MI): Date of Request: Hill Email: Request Type: El In-Person ❑ Mail t R"tin I Lehi ❑ Email ❑ Fax Street�A,cadre Vl l`UN i�V Phone Number: 7V n q _ �/\�� City,State,Zip Code: 0 Signature: V � a K41,J 5S 1I L,, Note: MS§ 13.05,subd. 12,persons may not be required to identify themselves,state a reasoA for,or justify a request to gain access to public government data.A person may be asked to provide certain identifying or clarifying information for the sole purpose of facilitating access to the data. Description of the Information Requested: rc f ►tGt�V��. Gh (�� IZ> 2n GIS C , I have read the information on this form and understand the city may charge fees to provide the information I have requested. I �' Signature Completed by Department— '�I Department: Processed By: Q - Y S Method of Response: )D In-Person ❑ Phone ❑ Mail Information Clas 'fication: ❑ Email ❑ Fax Public ❑ Private ❑ Non-Public �j Confidential ❑ Protected Non-Public Action: Approved Re uested by: ❑ Approved in Part(Explain below) Subject of Data ❑ Denied(Explain below) Not Subject of Data Remarks or basis for denial,include statute section: Identity Verified for Private Information: A Identification(DL,State ID,etc.) ❑ Compare Signature on Fite ❑ Personal Knowledge ❑ Other Note: MS§ 13.03,subd.3,authorizes the city to charge fees to recover costs to provide copies of data,including costs associated with searching,compiling,copying,mailing or otherwise transmitting data. Prepayment is required prior to receiving copies of data. There is no charge for inspection of data or for separating not public data from public data. Copy charges:es: - Method of Payment: ❑ (8%:x 11/14") X 0.25 ❑ Cash �#of pages) ❑ Check 1�1'(11x17") _X 1.00 .00 ❑ Visa (#of pages) Master Card ❑ Employee Time($ /hr) X hrs (only charge if over 100 pages) ^ ❑ Other Charges(attach explanation) eiv d Y 1Vnl Total Amount Due: a Date: "-2L This request will be reviewed by staff and the requester will be provided an estimate of charges prior to copying. If mailed,return form to: City of Orono,P.O.Box 66,Crystal Bay,MN 55323 City of Orono, 2750 Kelley Parkway, Orono,MN 55356 Phone: 952-249-4600 •Fax: 952-249-4616• Website: www.ci.orono.mn.us City of Orono 2750 Kelley Parkway Orono MN 55356 952-249-4600 Receipt No: 3.015768 Jun 13. 2016 CITY OF,ORONO ?IbU I!H LEY PKWY ORONO. MN 5b356 9 Stacy Martin 52 249 4600 Pig r VIL N I Previous Balance: .00 amt n. 166ia83 Other Revenue Costom., 1D: Street File for 845 46.00 Acc 9: 11/19 Willow Drive -------- ------- 101-34210 Parment Amount:X *46 UU General Taxable Sales/Service ---_------------- ------------------------- --------------- Total: 46.00 rime: Ub:e33:6 Date: 06/13,201b Contt,'oiation H: 34946553 - _______________ Credit Card Check No: 3595 46.00 . the Payment Amount does notinclude Payor: the Convenience Fee detailed belom Stacy Martin Total Applied: 1 au a to Pay total mount 46.00 acro, 1n c Gerd lssue ement -----------.00 Change Tendered: x--- -- - - -- --------------- Mere hart. r.oPY 06/13/2016 08:15AM