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HomeMy WebLinkAboutInformation Disclosure Request ORONO ADMINISTRATIVE OFFICES INFORMATION DISCLOSURE REQUEST MINNESOTA GoVMUR4ENT 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 yending or additional ou for six months edatat-on er unless a dispute or action 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. Date of Request: Requester Name: � �c_ _ Address: O City: �° i �/`/ �� •��v zip: ��;Ti7 Home Phone: 9 ©?3 Business : 93IZ- Cl Z,,4,-Z! Description of Information Requested: C✓=ff., 57. e6:_ Requester' s Signature: : BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY Handled By: Department: Request Type: In person Mail Phone Requested B Subject of Data Not Subject of Data Information Requested is Classified: Public Private Confidential Non-Public Protected Non-Public Request is: Approved Denied Approved in Part Remarks/Comments: Authorized Signature: Fees: Page Total Due No, of Pages Rate per g