HomeMy WebLinkAboutInfo disclosure request �
ORONO ADMZNISTRATIVE OFFICES
INFORMATION DISCI,OSIIRE REQIIEST
MINNESOTA GOVERNMgNT DATA PRACTICES ACT
REQIIESTER 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 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 of information
requested.
� ,
C �.
Date of Request: `�'� ���- ��� � � �`-�
'� � •--� � �
Requester Name: /C G� 'S C i r ��
Address: �% j5 c� �� c�Ct � �i �, r�_s� City: �� ��� ��: �c__
zip: � S �' `/ /
Home Phone: ��'� � L% � % % Busines s:
Description of Information Requested: �- i ���:- -f� � ''Z�� ���'«'" ��'`-�o
�� L ��' ��c _ /�i. .5-��--J ii
__�-_� ^ ' ,
Requester' s Signature: �— --�l� � ��c � ��- �� � �z �`�`
BELOW INFORMATION TO BE FILZED IN BY DEPARTM�?NT ONLY
Department: Handled By:
Request Type: In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature:
Fee s: x = $
No. of Pages Rate per Page Total Due