HomeMy WebLinkAboutInformation requests (4) ORONO AD�iZNISTRATNE �FFICES
I3`7FORMATION DISCLOSIIRE KEQUEST
MSNNESOT�. Ga DATA PR�CTI�ES ACT
' gLQIIEST�R 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 you for six montns thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g, You may be required to �n�ythet copies�so= in orm tion
certif ying and/or compz 1 g
requested. -
Date of Request: ' �` �c
Requester Name: ` < � ~�� .
2 G�'� ���� �,— ��ty: ��—���
Aaaress: �
_'��r/
Zip- �e � _ ,/ 6-- — ��
� � `� `�� Business- '�`�� �
gome Phone: ��7� ,
' ���
Description of Information Reuuested: „
� -- .�22� �i'
Re�uester`. s Signature: 'L�' ' "
BELOW INFORMATION TO BE FILLED IN BY DEPARTME?NT ONLY
Handled Bys
Department:
Reqnest Typ
e: In person Mai1 Phone
gequested By: Subjec� of Data
Not Su:n j ect of Data
�ublic Private
Information Re�quested is Classified: —
Conf idential
Non-?ublic -rotected Non-Public
gequest is:
Aporoved Denied Approved in Part
Rem.arks/Comme�ts: _�l'� ' �
�
f- ,.,.�. ?� `�%;�' G��-�S�'- /�:�'
. �� �4�s��./��'�--�
Authorize3 Signature:
_ $
Fees:• X Total Due
No. of Pages Rate per Page
Amount: $ �(J •'7 3 '�' .
Initials: l'�
REQUEST FOR REPRINT OF OVERSIZED DOCUMENTS
OR BUILDING PLANS AND BLUEPRINTS
Date of Request: _�f„ /�i
�Name: ' � n �� v ;� `�
Address: ��(r �7 7 ���.�
A�
City: /�.�J� � ��, State: �/�� Zip: _��-.� _3-:i
Phone: (Work) �U � � � �f �� �� � (Home)
Description of document(s) to be reprinted:
CHARGES: (the follo�,�ving c:�arges aze subject to rate changes)
Oversized Documents from Mi�rofilm
The charge for such reprints is the cost of copying service, Messenger service and a minimum
clerical fee of $5.00.
Buildin� Plans and Blueprints
The charge for such reprints is the cost of copying service, Messenger service and a minimum
clerical fee of $5.00.
All char�es must be paid at the time of the request, and are non-refundable. Requests must
be picked up ut the Ciry off cPs unless other arrangements have been made. If prints are
delivered an� Ficked up by a courier service, the charge for such service is to be paid by
requestor.
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ORONO ADMINISTRATIVE OFFSCES �
INFORMATION DISCI,OSURE KEQIIEST
MINNESOTA GaVERI�NT DATA PR�CTICES ACT
' gEQIIEST�K NOTEt
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 you for six monL'ns thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g, you may be requirec to pay actual costs in making,
certifying and/or compiling the copies o= insormation
requested.
Date of Request:
�i � l� l ��
, ���",�1.�.-�� � �;,��--� ������.
Requester Name: � � �� / � ,
�,� . , ,L L�_� city: �--r-r'.0�y� ��G�
Address: ��l (� ,i v�vc-x�� -�v��-2cti;�- � �� �
z
Zip: `� �� � ✓r
� � 3 �- G�' 1 c- ���-L
Hame Phone:��C�Z ����- ���%��'� Bnsiness_ �01 Z
' � ested: �_,`��_. �_�, �� 7 ��.�-��-. �'�-c�1
Description of Information Requ
;,
, �
��_.. _�-2C-�, , ` �.2C��,���
Requestes' s Si.gnature: „
BELOW INFORMATION TO BL FII�LED IN BY DEPARTMENT ONLY
Handled Bys
Department:
In erson Mai1 Phone
Res�uest Type: P
ested B Subjec� of Data Not Subject of Data
Re�qu Y= `
Information Re�qu
ested is Classified: ?ublic Private
Confidential Non-�ublic =rotected Non-Public
gequest is: Approved
Denied Approved in Part
Remarks/Co�ents:
Authorized Signature:
_ $
Fees:� X Total Due
No, of Pages Rate per Page :•
ORONO ADMSNISTRATIVE OFFICES
INFORM�TION DISCLOSURE RE4IIEST
MSNNESOTA GaVERI�NT DATA PR�CTICES ACT
' gLQIIESTER NOTE: .
A, Request Freauency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six months thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies oi in=ormation
requested. �
Date of Request: � 1 1�'f' I ��
Requester Name: C 4 � '�J�V�'�
Address: � �� �-A'
1Gk S T L-J � City: („)►'4r!2�'9'.T ►�.
zip: S �� Gl , .-� �.. 2,� 2�
Home Phone: `"� � � S �� � Business: � � �
Description of Information Res3uested: � ��^
- G��t c���� P'=�� �- ��- ���. cJ�J rn.��r��
� � �'�G=':x''_, L_r�Ffcc� I�c�-����� /td
�. �
Requester' s Signature: '^
BELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT ONLY
��2- Handled Bys d'
Department: —
In erson MaiZ Phone
Request Type: �_ P
g ested B Subjec� of Data �_Nvt Subject oi Data
�u �'' �
Inf ormation Rer�n
ested is Classified: � �ublic Private
Confidential Non-�ublic =rotected Non-Public
Approved Denied Approved in _Part
ges�uest i s: _�,
Remarks/Comments-
Authorized Signature:
_ $
Fees:� x Total Due
No, of Pages Rate per Page ••