HomeMy WebLinkAboutData request ORONO ADMINISTRATIVE OFFICBS
INFORMATION DISCLOSIIRE REQIIEST
MINNESOTA GOVERNMSNT DATA PRACTICES ACT
REQIIESTER 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.
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Date of Request: � � � �
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Requester Name: �� �f'��"/ ;�"1 ,�� � ��,'/l� i
, � , � _,� �-� �, City: /(�� /��
Address: j- > i � �� ,,�� < < �
Zip: -� , =, `%
Home Phone. -j�� �.��-,<' Business: '; %� � yy`!;,
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Description of Information Requested: -�i���� L��'i�� � ��� � '� (`� �
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Requester' s Signature: l i '� � �
BELOW INFORMATION TO BE FII,LED IN BY DEPARTM�?NT ONLY
Department: Handled By:
Request Type: In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Re�uest is: Approved Denied Approved in Par�
Remarks/Camments:
Authorized Signature:
Fees: x = $
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