Laserfiche WebLink
ORONO ADMINISTR.ATIVE OFFI�S <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> �+iINNESOTA GO DATA PRACTICES ACT <br /> REQIIESTER NOTE: . <br /> A, Request Frequency - Private Data on individua?s. After you <br /> have been supplied the data anci informed of its meaning, <br /> the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data -on <br /> you has been collectec. <br /> B, You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies oi information <br /> requested. <br /> Date of Request: /� <br /> Requester Names <br /> V� � � � <br /> � /" �_ City: <br /> Address: / <br /> Zip: ��1�/ % <br /> (� 7 L Business: � �C � <br /> gome Phone z ( ` � / <br /> Description of Information Re�uested: <br /> Requester' s Signature: � <br /> BEI�OW INFORMATION TO BE FII,LED IN BY DEPARTM�?NT ONLY <br /> Handled By: <br /> Department: <br /> Request Typ <br /> e: In person Mai1 Phone <br /> Ft ested B Sub j ec�- of Data Not Sub j ect of Data <br /> e� y' .. <br /> Inf ormation Requ <br /> ested is Classified: ?ublic Private <br /> Confidential <br /> Nan-Public -rotected Non-Public <br /> gequest is: Aoproved Denied Approved :in Part <br /> Remarks/Co�ents: <br /> Authorized Signature: <br /> _ $ <br /> Fees: X Total Due <br /> No. of Pages Rate per Page .. <br />