HomeMy WebLinkAboutrequest for property info � ORONO ADtrLTNIS�R.ATNE OFFSCES �
=�7E'pRMATION DISCLOSIIRE RE4�ST
� MSNNESOTA Ga DATA PR�CTICES ACT
• ggQUES2'ER NOTE: . -
g, gecruest Frequenc� - Private D a infor�ed� ofaitssmeaning, the
have been supplied the aata an ou for six mon�chs thereafter
data ueed not be disclosed to y
.unless a dispute or action is pendina or additional data -on
yvu .has been col.Iected.
g. you may be reauired to pay �actual cos�s in making�
certifying and/or com�iling the co�ies o= in=ormation
requested. •
Date of Request:
�';� �?L' ��'�
� �`q�' �C-�' S. .SG�v%�i
ester Names
Req'a . �'
_� �� 7� S j,F'C ��� City: ����
p�ddress: � �
Zip: Ss j Z % /, ��/�-
��. L�S� . L�`Q �C` Business: G�� '�r
gome Phone:
Description of Information Kea_uested:
�'%���' /����� C'
Recruester`. s Signature:
,,;;����-�:�l '�----�'
BgyOW �7gORMATION Tb��E FII+LED IN BY DEPARTMSNT ONLY
'�_� ; Handled By= �.
D ep ar�ent: _--� ;
Mail. Phone
gequest Type2 _�.In pe=san . — —
gequested By= —
Subjec� of Data Not Sui�ject oi Data
Tnformation R�qu
ested is Classi.fied: ?ublic _Private
Nan-?ublic -rotected Non-Public
Conf idential --
Approved Denied A�proved in_Par'�
gequest is: _ --
Remarks/Co�ents:
Anthori.zed Signature:
= S
Fees:• X Total Due •-
No. of Pages Rate per Page
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housa pi or ancfllary drt� sswcl���d wlth �hn dstign •nd
con`�rvc � ot mY hous� st 4ba0 O�hl Rp„ Mour�Q, MN 56364.
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