HomeMy WebLinkAboutInfo request ORONO ADMSNISTRATIVE OFFICES
INFORMATION DISCLOSIIFZE REQIIEST
NiINNESOTA Ga DATA PRACTICES ACT
° gEQIIESTER 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 y nding or add ti nal edatat�on
unless a dispute or ac�ion is p
you has been collected.
B, You may be required to pay actual costs in making,
certifying and/or compiling the copies oi information
requested.
Date of Request: � ���� � /
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Requester Name= I\ � �/ ��-� `�C �ls��n `
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Address: � J,�'u �'/1-�� � � � � ����`
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Home Phone: L�-�'X�'��- Business : T � � � �"�`-
Description of Information Re�queste3:
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Requester' s Signature: ��'� � �
BELOW INFORMATION TO BE FII�LED IN BY DEPART�?NT ONLY
Department:
Ha.ndled By:
Request Types
In person MaiZ Phone
ge�quested By- Subjec� o= Data Not Subject of Data
Information Requ
ested is Classified: ?ublic Private
Confidential Non-?ublic =rotected Non-Public
ge�uest is: APP
roved Denied Approved in Part
Re�arks/Co�ents:
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Authorized Signature:
C��i���- �-����,� -
_ $
Fees: x Total Due
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