Loading...
HomeMy WebLinkAboutMisc C� `1 �3d � ?�OY Project �ss�o� Project No Page Client � D c�� �, ared by Date : 1 1 1 yv Calwlations for �� ��,�� r� � Reviewed by Date v 4 /l2 -��3 zo� �,JS_ �, s;. _ _ _ __ � - '� _ (�'r S,Z e i�5�X �0 z 1 Y�c9 t� b s� ��_. �f Co u -P..�A�, d}.l{o v�1 ec9 �`{� 0�U �G. t S°rB = Z, I l�� � �q- L�'X�s;,� /�-a,,s..o I �y 2. _ _ _ �/� Y Z K � � � t sy�--,� 6 y s ; ; _. _E 5c�=� _ � �_._,_ : : n- ' ' ' Z Z Z b - ZI o O � l 2 lo �3 c-� -i'� p J--� I S°Tv HA/�k��-�. 3 s°10 � �-c��� _ , � ��r,vov x�S�Q = �i,°tac�s� _ �1i I'Si l/v� vN KNO�..�N . __ . ; �pr�R�A�CP (l.��j J �.iL�✓J �J e `4-r� `�'��lnJ (�p't f.��'"� t/�!`�/�v� --�-� rr�� `�n.��G P,� S-rn�►�-r,��c,z ��'6•s�vz-s� A��vo ��c c�ss �r ,S,'yi.�/'c�-vf�c. Go�-e/��2 ._ � � ; _ i ° s � � , __ : � _ _ � _�. ,., s� _... � _.. _.. �.. _�. _�..._..�.. ...._....�. . � , � . , i �..._ _ _ ,......_� _ ', � , , _ � . _ _ _ _ __ ..... ......... __w...�,. , ,,,, ,,,,.,. __..,., .�..... , „,,,, ...,._..._M _._._ ..�. __�_� A. REOUESTER COMPLETE!lf�me 1-S) HENNE�IN COUNTY _22_ ' , ��E F NEOUEST INFORMATION DISCLOSURE REOUEST � °�q ° Minnesota Government Data Practices Ac! l S7E NAM �usc. rsc.�.1 AEGUElTEN NOTE: S� ��' C A. R�qu�st Fnou�nry—Pnrab Olt�on inC�v�Cuali.Att�r you�avt DNn�J tn�Oaa and��}orm�d of its m�aninq.tM Oata nNa not D�Oisc�os�C to y� AODRESS Irl nMO�01 � �U[TOf1th!thf���fSH Uf11t33�Ci�DUt�Of aCSiOA q D��O��q Of�Ctl�liOflll Oit� � �C �.�r �� Of�YCN hai DN/1 COtIKttC. � _ _„_ � �. MONE id nMo�a 8, You msy D�r�OwrM to D�Y tM actwl cosri of m�kmp,CMifymy tnC/or \ � �� `^,�� �C ��-� WmD�ilnq M�caP��01 intormauon nqu�ft�C. '�J Y ` J a OESGii1��ON OF TME iNFOR�TiON REOUES i ED �n f J 1 ` �sr��....,,r ��.�.. 1 5� y���,� — s oues7eR s+c.++wruaE X .. _. - •----• _ . . _ 8. DEPAATMENTIOIVISION COMPLETE �. qE0uE5T w►NO�ED 8r 6. DEP�ATMENiiD�viSiON NA►rE f, REOUESTED ilV: l AEDUEST T�'pE � p i�.q.rsa� ❑ �ta�i O P►+� p s�ei.or n»aaea ❑ Not tf+�wbj.of t��Cna ta TME iNFOR�A710N AEGUE57�0 IS Gu►SS�F�ED: 11. AEOUEST - ❑PUBUC " ❑ NO�UBUC ❑ADP��4 ❑O�n��d ,�j ApP►�'b�n D�*t(�:Ola�n m 13) � PR�yA� ❑ PpOTECTED NON-PUBLfC tt�u�NOp�ZED S�GN�TUNE ❑ CONFIOENTIAL ' X 71 pE►uctKSiCAu►iENTS�u rw�.�rna aar�y auanwo ao��ro o�n��ar+ro m�nowr�r ex��urnoi�ry d n�son.�uo r�nr�rrf orn�r r�m�rrs,cornnrnn�aoroa��ai. C. DEPARTMENT/OIVISiON COMPIETE WHEN FEES ARE ASSESSED (A rscsipred coAy ol this lorm is to Ds provided to tM requssier�ic t/me mon�y is r�ceived). � ��' �FEES:FLAT RATE • t1 ❑FEES:SPECIAL RA7E(Compl�t���0�tqtA/ortn NC 1370 wh�n oth�► x rA�n t1»fUT RATE or STANDAAD fEE SCHEDULE�s us�e.l {NO.OF P�GE51 •Sw MmM_Wnwl fa fLAT MTE Nnount I Am nc�+vW hom tM aDov�nam�G.th�amount inaicatW opP��t� my s�qnatur��n paymtnt fot prpwd�np th�mfOtmitiOn rpuKtld. TODwrS DATE 16. � pECfiIVED BY TOTAL AIMOUN7 OUE S + r00wr5 OwiE 17A. AMOUNT TO SE�EPAIO � AECErvED Sr � � � l30�o�Mt.totl!�l o.+�it0.001 = � TOOAr'S OATE t 7B. 6AW'�GE DUE � AECEIVED OY 1 ruoa+cow�a«.on a eonww/ S D. REOUESTER PLEASE NOTE iTEMS CHECXED �� " '1. � Mike checfc/money order payable to: Z. � I! mailed. rotum �ntiro form and any fees to: - MC 1506(2-8 REOUE57ER COPY/RECEIPT •