HomeMy WebLinkAbout#1341 Data Practices Act formORONO ADMINISTRATIVE OFFICES
SNFORMATION DISCLOSURE REQUEST
MINNESOTA GO DATA PRACTICESACT
REQIIESTER NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the aata and informed of its meaning,
data need not be disclosed to you for six months thereafter
Bless :'a dispute or action is pending or additional data -on
you .has been collected.
you may be reauir.ed to pay actual costs in making.
B. cer .• and/or compilin the copies or inf,ora tion
s- .if Ying
requested.
�l j
Date of Request:
Requester Name:
City
Aaaress :
_lusiness:
Home phone:
Description of Information Requested:.
Requester's Signature:
BELOW INFORMATION TO BE FILLED IN BY DL'FAR .T ONLX
Handled By:
D ep went :
Mail Phone
Bequest Typ= e= In person. —
Suh4ecof Data Not Subject of Data
Req-aes-tZed. By:'Public —Private
Tnfornat_ .on Reque
sted is Classified:
_Confidential
Non -Public _=rotected Non -Public
Reclaest is: Approved
Denied Approved in_Part
Remarks/Cc�ents:
Anthon-zed Signatara=
= S
Fees: x Total Due .
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