HomeMy WebLinkAboutInformation requests OR0210 ADMINISTRATNE OFFI�S
rNFORMATION DISCLOSDRE REQU�ST
MINNESOTA Ga DATA PRACTICES ACT
ggQUESTER N��- � - p� vate Data on individuals. Af ter you
A, Request Frecruenc� i
the
have been supplied the data and Quf fo eSiX=mon�sethereafter
data need not be disclosed to Y �
ute or action is pending or additional data -on
unless a disp .
you has been col.Iected.
B. you �ay be required to paY
actual costs in makin9.
certif ying ar_d/or ���Pi ling
t'r.e copies oz in=ormat�on
requested. �
Date of Request:
��� _ a L.( - �� �
' - _3_ �j l� js�
Reqnester N�e= �- �
Address:
�U � `-( �' �� �� �.. ` j�� �f�c� • City: �; /:G��' c_i —
z�p: �l �� - � � =� J
H�,e Phone: Ll l � -- �. "3 � �7 Business:
Description of Informa-t�on Re�u'este�.:
� ll,��� � �� I �-
� �v,�� ..• a�
Reqaester' s Signature=
BgyOW IIrTFORMATION TO BE FII�.LE� IN BY DEPARTM�NT ONLY
_ ��. � Handled By: �` ` v'
Departsi.e-nt•
Request Type= � In persan
Mai1 Phone
Subje�� o= Data
�_Not Sub j ect of Data
gecrueste3 BY= —
Tnformation Requeste� is Classified: oC
�u�lic _P'-'i`rate
Non-�ublic =rotected Non-PuDlic
Coniideztial —
gequest is: Aporove�
Denied Approved in Part
Rem.ar�s/Car��ts:
Authon-Z� S1gaature=
_ $
x Total Due
Fe�s� No. of Pages Rate per Page �-
ORONO ADZ"iIN=STR�T�E OFFI�S
=NFOR�IATION DISCLOSURE K�SZ�ST
MSNNESOTA Ga DATA PR�C'r=CES ACT
RESZUESTER NO�� oT ou
A. Request FrecTuenc� - Private Data on individuals. Af t"� the
have been supplied the data and uf fQ eSiXf�ontnsethereafter
data need not be disclosed to y
un1ess a dispute or action is pending vr additional data -on
you has been �oZi e����• z�tual costs in making,
B. You may be required to pay iT1L02'III�L'on
certifyinc ar_d/or ���Piling ti:e copies o=
requested. �
- ,� � �� /
Date of Request: �
� �``"��_
Reqzzester Name: L-'(-��` , � t � �����
Address:
�, ' LC� � �✓�� J��'�� Y
z ip: `' `' � �' `� _ c� � ' _ �5 3 �
j � �, _ c.� � �. _ � 3 :� � Business:
� L ��
g�e phone: �C'
Description of Informat�on R�ueste�.:
� �� �; �D � �-�',r-�-�-��� ��- 5 ,
�V `� ��, �__ f ��, ;'L. f� ,�l
Reqtzester' s Signature:
BgyOW INgORMATION TO BE FII�LED IN BY DEPARZ�NT ONLY
Handled BY=
D epartme.nt=
r� �erson
Mai? Phone
Request �'ype= —
' �:. or" Data Not Sub-ject of Data
Recruested BY= _Sub�e_- —
Tnfo�ation Re�Bested is Classified=
�ublic _Private
*7or�-?u91=� =rotected Non-PuDlic
Confident�al —
Denied A�proved in Par�
Rec�aest is: Approve^� — -
Re.narks/Car�ents-
Autlzorize� Sigriature:
_ $
x Total Due
Fe�s: a es Rate per Page "
No. o= ag