HomeMy WebLinkAboutrequest for info ORONO AD:�i�IIS�R.AT=VE ��=�S '
�i�7'r ORMATIO:1 D=SGZOSURE REQIIEST _
• - ��gSp� � DATA PR�CTICES B.CT
• ggQIIES��K NOTE: . -
A. T�a�ZQS't Frequency - P=ivate Data on individuals. p��e= th�
have been supp3.ied the aata and inforuzed of its II.e�ning�
Qata �e�d not be discl.osed to you for six �onL:ns thereafter �
. .tin 1gSS �� dispu�e or ac��on is �pending or additionz.l data -on
you .has been. coll.ectec. �
yQu aay be reauired to pay ��actual cos�s in �aking;
B • zhe copi.es o� in=oraztzor_
certifying and/or co�ailing
=eauested. •
Date o� Recruest: 5 - 2' q - O � �
gequester Name: c�l��``�E S v�, ��'�-}�✓5oN .
�dress- � 300 �,c)/}-7��� T�W/� ���
City: �`�/-���� �L I�ll✓
. Zip: �'S35�y .
Hame Phane: �f S2- �/ 7 S - 31 S j Business:
,� �i rs �-
Descr�pt=.on of Information Requested:. �UI�D/NG p 1�
c s �o� a a o ci� �Pr-�� a s �i-+ �P���v � �
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� Retraester'. s Si.gnature:
BEI�OW INFORt�iATION _0.- E FI
I BY DEPAR�N� 02�LY
6� 2-- Haudled Fy= �� '
D ep ar�e.�t=
Mail. Phone
ge�uest Type- �_Zn peYsan — --
Subjec� o= Data PC Not Subject or" Data
g�ues�eci By= `
�fo�atj.on Requested is Classifi.ed:
D� �u'r�lic _Private
�;a�-?ublic _=rotected Nan-Public
Con=�dential -
Denied � Aoproved in_Par�
g�cruest is= OL Aooroved — � ' .
Re�arks/Coarments- .
p,II.�ori.zed Signat�xe: .
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