HomeMy WebLinkAboutRequest for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSIIRE REQIIEST
MINNESOTA GOVERNMENT 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.
Date of Request: �i? �d'� f � �
Requester Name: ��� \ / �
,�Address: � .3' � �� � � ' � City: ' �, •�
Zip: � C.�� ' )
Home Phone: ����� �� a �^7� Busines s: �"� ` � � � I 1 ��
Description of Information Requested: � �� �e � V11t l
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Requester' s Signature:
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BELOW INFOItMATION TO BE FILI�ED IN BY DEPA� ONLY
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Department: � '��- Handled By:
Request Type: pL In person Mail Phone
Requested By: Subject of Data r�_Not Subject of Data
Information Requested is Classified: �Public Private
Confidential Non-Public Protected Nan-Public
Request is: �Approved Denied Approved in Part
Remarks/Comments:
Island:474-1958 Homc: 892-7876
Authorized Signature: ,�„— Board of Governors
Big Island Veterans Camp
Fees: x Disabled American Veterans
No. of Pages Rate per Page Representative
Patrick K. Healy