HomeMy WebLinkAboutinfo request ORONO ADMSNISTRATNE ��=�S
INFORMATION DISdDAAEPR CTICES ACT
� ISSNNESOTA Ga
' gEQffES�F•R NOTEt .
A, geauest Frequency - Private Datinfor�d of itssmeaning, the
have been supplied the aata and ou for six monu�s thereafter
data rieed not be disclosed to y
�unless `a dispute or action is pendina or adaitional data -on
you .has been collected.
g, you may be reauirec to pay actual costs in making.
certifying aad%or comailing the copies oL information
requested. •
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Date of Request: `
� - ' �� �
Requester Name: ,
> � / � City: �
Address: �4�J� ( ���.c� C� �
.� 53�� 1 �
Zip: - .
�/f - Business: � JU" a �� � G
gome Phones �
Descript-ion of Information Reuuested: r /
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Reuuester`. s Signature:
BgyOW �7gOR�`�SATION TO BE FII�I,ED IN BY DEPAR�� O�Y
Handled BY=
Department=
Mail Phone
gequest Type: In persan . — —
Subjec�- of Data Not Subject of Data
ge�uested Sy= — `
Tnfoimation Requ
ested is Classified: ?u�Iic Private
Con=idential Noa-?ublic
=rotected Nan-Public
Approved Denied ABproved in_Part
gequest is: --
Remarks/Camments:
Antb.orized Signa
tBre: �
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Fees:- X Total Due ..
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