HomeMy WebLinkAboutInformation requests ORONO ADMI232STRATSYE ��=�S �
1�`TFORMATION D=SCLOSIIRE REQIIEST _
• � �42NNESOTA GO DATA PR�CTICES gCT ,
� gEQ�ES�EK NOTE= .
�. pecrt:est Frequency - Private DatinfQr�d ofaitssaezning, th=
hac'e been supplied the aata and ou yor six nont:ns thereafter �
nata nead not be disclosed tO yending or additional data -on
. .unless .`a dispute or ac�ion is �p . . � .
you .has been collected. �
g. you may be =eauir�ec to pay��actual costs in �akinq,
certifying and/or co��iling the cooies or infora.ati�r
requested. `//�� D •
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Date of Re�es�: �
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Rec�aester Name: - ������'�
. /,� � , City: v
Address: �/ `
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Business=
H�,e Phone� I
Descr u
' on f o ation R _ ested:_ '
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Rea'�eS�es'. s Signature:
BFyOW INgOFtMATION TO BE FIIZID IN BY DEPART�'—''x� O�Y
Hanaled bY=
D ep ar''"�.ent:
M�iZ Phone
gequest Ty�e= In person . — —
y: Subjec� of Data
Not Sui��ec� vr" Data
geqaes�ed B —
�ui�lic _P='ivate
Tnfozm,at=.on Reqaested is Classifi.ed: —
Naz-?ublic -rotected Non-Public
Coniidential ____ ;n pzt
Denied � Aoproved __
ge�-¢est is: Aoproved — �
Re.�arks�Cu�mests-
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p,II�orized Signatare: `' :� ;,;, .
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Fees:• X Totzl Due „
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ORONO ADMINIS�R.ATNE OFFSCES
INFORMATION DISCLOSIIRE RE4IIEST
� IiSNNESOTA Ga DATA PR�iCTICES ACT
• gBQIIES�ER NO�E=
A_ Request Frequency - Private Data on individuals. After you
have been supp?:-ea the data and informed of its meaning, the
data need not be disclosed to Yenaing or add tional edatat�on
unless a dispute or acti.on is p
you .has been col.lected.
B , you may be required to pay actual costs in making.
certifying and/or compiling the copies o= in=ormation
requested. �
Date of Reques-t: J� ���' � �
; . / { �-.
�-��,�' �,,'�t � y �
Requester Name= r- �r
c �. �.���c-� r
�_ � c' � City: C
AC3d2@SS: �c � ^ �F�z </j� i
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Zip- l;_ �.-"j � �/
� �i�� �' i �� Business:
Some Phone: �i �� � ' �� �
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Description of Information Reuuested:
C � �` �7 /-�? ':, /'� ,�"�� �)'�/� ��l, .
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e: >'�`"��_ - .�-�z� �.� r� _'
� gequester'. s Signatur =� �"��� � �
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BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONI,Y
� �Z Handled By: .•�
D ep artment=
Reqaest Type= /� In pe'-"son
Mail Phone
geques-�.ed By:
Subjec;. o= Data �_Not S��eC` �= Datz
Inf ormation Requ
ested is Classified: �_�ublic Private
Con=idential
Non-?ublic =rotected Non-Public
Approved Denied P_pproved in_Part
gequest is: ,�_ —
Remarks/Ca�ents:
Autb.orized Signature:
_ $
Fees:• x Total Due ..
No. of Pages Rate per Page ..