HomeMy WebLinkAboutRequest for information ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCI�OSIIRE KEQIIEST
�+iINNESOTA Ga DATA PRACTICES ACT
RE4DESTER NOTE:
A, Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data needdistute orsaction is pendina or add tional edatat-on
unless a p .
you has been collectec. �ctual costs in making,
g, you may be required to pay
certifying and/or compiling the copies o= iniormation
requested.
Date of Request: ��� �� � �
� ,5 Gz- ia „� J� a �� �
Requester Name:
,—� ) v� O �1 C�
�ddress: ���' �` � S/� ��� � City:
zip: �s`-�3 /
Home Phone: L� � 3^
2� 3 S� Business:
Description of Information Requested:
Requester' s Signature:
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gELOW INFORMATION TO BE FII.I�ED IN BY DEPARTME?NT ONLY
Handled By:
Departsnent:
In erson MaiZ Phone
Request Type: P
R ested B Subjec� or Data Not Subject of Data
� y:
Inf ormation Re�qu
ested is Classified: ?ublic Private
Confidential Non-�ublic =rotected Non-Public
ge�uest is:
Approved Denied Approved in Part
Remarks/Co�ents:
Authorized Signature:
_ $
Fees: X Total Due
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