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Home My WebLink AboutInformation request OROIIO ADHSNSSTRAT=VE ��S ' INFORMATION DISCLOSUKE Kti'4�ST • � tfSi�NESOTA GO DATA PR�CTICES ACT ' ° gEQUES�F�Z NOZ'E= • A. gequest Frequenc� - Private Data on indiciduals. ��te= �ho h�c�e been supplied the aata and ouf fo eSiXfnon'r�_'r�se herezfter � a�ta n.e�d not be disclosed to y .unless ��a dispute or ac�ion is �pendinQ or additional dat� 'on you .has been col.Iected. � you m,ay be reauired to pay ��actual costs in �aking. B. the co�ies o� in=oraatior_ certifying and/or co�piling reauested. `�/�� O • Date of Request: r ` �e= � Rea-uester N " �;��,/� . �,� � City: � A.d�re s s: ��/ ` ZiD- Business: H�e Phone= I j_ Descr tr � on f o _ ation R ested: � � ,c�C.� � � . J gecrues�es'. s Signature: gELOW 1NFORMATION TO BE FII�F� IN BY DEPAR��'�N� ��'�-' sa.xiale3 sy: D ep ar`"��'�= Mail Phone gequest Type= in person . — — gequested By= — Subjec� o= Data Not Su�je�� o= Dztz _�Z,� Priv�te Tnfo�mation Requested is Classifie�d: — --- Naa-?ubli.c =rotected Non-Public Con=idential � Denied Annroved in_Part gecruest is: Aooroved — . Fze�arks�Car�ents- � ' � /. , An�horized Signa tare: Gi" � k� � � � � - •% ' = S Pees:• X Tota� Due „ No. of Pages R�te ver Fage , ��(/� /�� y � ��'�- _ l .�; � � � ��r s �� ,��,�� 5� . � � � � � � 3� � o� . � , �� 3 0 3� �z�� - r �� l � � � ��{,;��'° _ .� _ �� /� C 7� ��, , � 1 � b �so -�� -�- /�� _ � � � � � � �s �� l � �� a�. � � ,�� S� � � O � � � 1 � � ' � � ^ '� � � �� 2, � � � � �� . � �� , _ � � � � . � , �� S �� , �� . ✓ � �� s _ �� ,o � � � � ��