HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISL�OSURE RE4UEST
MINNESOTA GO DATA PR�CTICES ACT
' gEQIIESTER NOTE=
A, Reqnest Freauency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need nat be disclosed to you f or six montns thereafter
unless a dispute or ac�ion is pending or additional data -on
yvu has been collected.
B , you may be required to pay actual costs in making,
certifying and/or com�iling the copies oi inr"ormation
requested.
Date of Request: �3
. � _.
Requester Name: '
Address: �1��� •�1 � CitY:
z�P: S�35/�"
Home Phone• y��/-=�.��o Business: �74- `JG44
Description of Information Re�quested: _ 4
. �
- r
Requester'. s Signature:
BELOW INFORMATION TO BE FII,.LED I� BY DEPART�?NT ONZY
Handled By:
Department-
Request Typ
e: In person Mai1. Phone
g ested B Subjec� oz Data Not Subject of Data
e�u Y=
Inf ormation Re�qu
ested is Classified: �ublic Private
Confidential Non-�ublic =rotected Non-Public
Request is:
Approved Denied Approved in Part
Remarks/Co�ents:
,> :.
'';�,_� ��__-��``��-
�
Authorized Signature:
� � _ $
Fees:� x Total Due
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