HomeMy WebLinkAboutRequest for info ORONO ADMINISTR�TI� ��ICES
INFpRMATION DISC.LOnA�EP���S ACT
MSNNESOTA GO .
ggQIIESTER N��- - Private Data on individuals. �fte� tne
p,, Request Frequency
have been supolied the data ana" Quf fo esix montnsethereafter
data need not be discZosed tfl y
ute or action is pending or additional data -on
unless a disp .
you has been coZlected. costs in making,
v be requireci to pay actual
B. ou may t:e copies o= inr"ormatior.
certifying ar_d/or compiling
requested• �
Date of Re�uests 1 � S .
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' ; , I�f�t' .��.L L�---� ,�
ester Name= `� " "�" �'�
Requ - � � City: �� L�_.t� f
Addr e s s: ,'��`��/ �-' '
zip= �� 3 ��
- c Business : � 7�, _`��'��G
H�e Phone: r �� —
o�a�on gecruested:
Description of � � 4/,c� .
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�C�CSter` s Signature: �
BgyOW �NFORMATION TO BE FII,L�D IN BY DEPART��T O�'Y
n - .� Hasdle�d By:
�• � .
D e artm�t= 'i�
� � Phone
Mai_. —
Request Type= i'` In persen —
Recruested BY: —Sub j ec�
of Data � Not Subje�� of Data
���I�� _Private
Tnfo�mation Reques�ted is Classified:
Non-�ubl=� =rotected Nan-puDZic
Confidential —
Denied A�proved in par�
R�eS.� is: �C_Aporoved — _
Re�ar3�cs/Cauffients-
Authorize3 Signat�re:
� _ $
X Total Due
Fe�s: es Rate per Page ..
No. of Pag
OROHO ADMSNISTR.ATIVE OFFS�ES •
�TFORMATSON DSSC�DA� PR �=�S �.CT
• � �iS3�Iv�ESOTA GO ,
• g�?QUESTEK NOZ`E=
A, gecrtaest Freauency - Private Data oa iudividuals. �'��e= th�
have been supplied the �as a to a ouf fores�xfnon�.:nse hereafter -
data ne�d not be disc1 Y
�-ion is •pendiag or additional data �on
. � .unless ��a dispute or ac.. . _ . . . .
you .has� bee�. coll.ected. _
you may be reauired to pay��actuz.l �cos�s in �akinq;
B' and/or co��iling Lhe copi.es oi inforazt�or
certif ying
=eauested. '
,
Date of Request: J '��'.'�v�Lti�� f
. - . ���� � �� 'i Y�.
e: �
Req'aester Nam .
, � City: ��'�,,��<� i — �
Ar3d.ress: ��J� S S--f�'t S '� t'7, '
� Z ig: �� `��(� �-
Business: /ol yr3 3S-��� _� —
S�e Phone=
ormation Retrueste3:. Lr�
Descript�-an af � �
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, �
Si a��e:
� Rea'uester'. s 9'n PAR��N� ONZY
BgLOW =NgpgMATION TO BE FII�LED IN B
Handled bY=
D ep art'�.e�t= Phone
In persar_ Mail —
gequest Z`YPe= — • —
Sub jec:. o= Data
Not Subject o= Data
R�ques�ed By= —
�fo�ati.on Req'aested is Classified=
�ublic Private
�ublic
Nan-?uDZic _=rotected Non--
Con=idential. — . . � � � _ � Part
Denied � P_�oroved n_
Recrues:t 1S: Aooroved — �— �
Re�arks/Co�ents:
gn�ori.ze3 Signa-tBse: �
_ $
x Total Due „
Fees:• eS g�te per Page
No. of Pag .