HomeMy WebLinkAboutinformation request ORONO ADMINISTRATNE OFFI�S �
INFORMATION DISCLOSIIRE RE4IIEST
. MSN�TESpTA G� DATA PR�CTICES ACT
• ggQt7ES�ER NOTE: �
A. gequest Frequency - Private Datinfor�d ofaitssmeaning. the
have been supplied the aata and ou for six monL:ns thereafter
data need not be disclosed to y
unless a dispute or ac�ion is pending vr additional data -on
you .has been col.Iected.
g. you may be reauired to pay actual costs in makinq,
certifying and%or compiling the copie5 oi inforaatior_
requested. -
Date of Request:
Fi � 1 1 �-�
� � � • � �, j (�e.n i.�c �,..,-,—.}- L ��
Requester Name: w � � �"S .
� ,. City: �f �''� �
�aa=ess:
D� R� � �
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Zip:
H�e Phone: � � �
- r S � � Busines s: L-'��` �``. `"�J
Description of Information Reuuested:
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Reuuester'. s Signature:
Bg�,OW INFORMATION TO BE FII�LED IN BY DEPAR�NT OZTLY
Handled By= � � • —
Department= Q � Z
Mail. Phone
gequest Type- �D _In person . — --
gequested $y= —
Subjec� o= Data �_Not Sui�ject of Data
Tnformation Requ
ested is Classified: _���Ii� _Priv�te
Conf idential
Non-�ublic =rotected Non-Public
A��roved Denied Anproved in_Par't
gec�aest is: �_ —
Re�arks/Co�me�ts:
Anthorized Signatare:
_ $
Fees:- X Total Due _.
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