HomeMy WebLinkAboutInfo request ORONO ADMINISTRATIV� �FFICES
INFORMATION DISCI,OSIIRE REQIIEST
MTNNESOTA Ga 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 montns thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g. You may be required to pay actual costs in making,
certif ying and/or compiling the copies oi information
requested. _
Date of Request:
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Requester Nam.e: -,
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Address: �l'' `
Zip-
Home Phonez Business :
Description of Information Requested:
Reqaester: s Signature:
BELOW INFORMATION TO BE FII.LED IN BY DEPARTMF:NT ONLY
Handled By:
Department-
Request Type:
In person Mai1 Phone
g ested B Subjec� of Data Not Subject of Data
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Information Requ
ested is Classified: �ublic Private
Confidential Non-�ublic =rotected Non-Public
geqnest is:
Aporoved Denied Approved in Part
Remarks/Commentss
Authorized Signature:
_ $
Fees: x Total Due
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