HomeMy WebLinkAboutinfo request ORONO ADMSNISTRATIVE OFFICES
INFORMATION DISCI�OSIIRE REQIIEST
MINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE:
A, Request Frequency - Private Data on individuals. Af ter you
have been supplied the data and infornted 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 information
requested.
Date of Request: � - ��2� ���
Requester Name: �- NJC.�" t-t � L �E�tt�l�- .
Addr e s s: j 3 S G �o`'l �� 5T Ci ty: �P�ip�f p�-i►�
ziP: �5�35�1
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Home Phone: - �° � s Business:
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Description of Information �tequested: �� v
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Re�uester' s Signature:
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BELOW INFORMATION TO BE FII,LED IN BY DEPART�iENT ONLY
Department:
Handled By:
In erson Mai1 Phone
Req�aest Type z P
Re�uested By- Subject os Data Not Subject of Data
Information Rer�uested is Classifie�:
�ublic Private
Confidential Non-�ublic -rotected Non-Public
ge�uest is: Approved Denied Aoproved in Part
Remarks/Comments:
Authorized Signature:
Fees:� x $Total Due
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