HomeMy WebLinkAboutinfo request ORONO ADMINISTRATIVE OFFICES
INFOFtMATION DISCLOSIIRE REQIIEST
MINNESOTA GOVERNM$NT DATA PRACTICES ACT
REQIIESTER NOTE:
A. Request Frequency - Private Data on individuals. Aft�- u
ha�v�-��e�-sug�lied the data and informed of��--�t��iin the
data need not be c�i���i-e�d_to you_���-�x months t eafter ; �' •� _ �
unless a dispute ��r�-o�—i� pen3i�r�—e�--a�d_itio�x data on \
you �a-�-�een oc llected. � �_'------_-_-.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of �Request s �0������
� � �,/ ,, --
Requester Name: =C y�"I � ;' i ' l�
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Address- �0 /.1i(}'� ,� i�a..: , City: Jf f";1r:,('
Zip: V� /�/
Home Phone: �� ���� - '';��� Business:
Description of Information Requested: �'��:�'�,�� �-���r^
Requester' s Signature:
BELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT 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/Camments:
Authorized Signature:
Fees: x — $
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