HomeMy WebLinkAboutinfo request ORONO ADMINISTR.ATIVE OFFSCES
INFORMATION DISCLOSIIRE RE4IIEST
��Sp� Ga DATA PR�CTICES ACT
' gF;QIIESTER NOTE: .
A. Request Frequency - Private Data on individuals. A�te'-" Y°u
have been supplied the data and infor�ed of its meaning, the
data need nat be disclosed to you for six �ontns thereafter
unless a dispute vr ac�ion is pendinq or additional data -on
you has been collected.
B, you may be reauirec to pay actual costs in making,
certifying and/or cont�iling the copies o= in=�r�zti�n
requested. �,�, � `� •
✓ �,�'r�
Date of Request: � ,
` � �1��� i /��� �,
Requester Nam.es
l / ' �
�� l�7 ���� �� , City: '
Address: '� �� � �''� " � �
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zip= ����. � � ��
� � 7 Business:
Hame Phone: %� �
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Description of Information Reuuested- �"
/
,
Recruester'. s Signature: ��
BELOW SNFORMATION TO BE FII�LED
Y DEPARTMENT ONLY
� ' Ha.ndled By�
Department:
geqaest Type= In person
Mail Phone
Subjec� of Data Not SubjeC� o= Data
g�quested By: _ `
Tnf'o=m,ation Requ
ested is Classified: ?ublic Private
Nan-?ublic -rotected Non-Public
Contidential _
Approved Denied ADproved in_Part
gequest is: _
Remarks/Camme�ts_
Authorize3 Signat�re:
_ $
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