HomeMy WebLinkAboutre requests for information �IU-� ` ' ` '
ORONO ADMINISTRATIYE OFFI�S C g� � � , ,
2NFORMATION DISCLOSIIRE REQIIEST
MIN�N�ESOTA Ga DATA PR�ICTIGES ACT
' REQIIES��R NOTE: .
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
data need not be disclosed to you for six montns thereafter �
unless a dispute or ac�ion is pendina vr additional data -on
you has been collected.
g. You may be required to pay actual costs in making,
certif ying and/or compiling the copies oi in=ormation
requested. �
Date of Request-
,
Requester Name: � , r � I
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p�ddress: %� C: �C.� t ^
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Reuaester'. s Signature:
BFZOW INFORMATION TO BE FII,LED IN BY DEPART�NT ONLY
Handled By:
Departscent:
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g ested B Subjec� of Data Not Subject of Data
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Inf ormation Requ
ested is Classified: ?u�li� Private
Confidential Non-?ublic =rotected Non-Public
A�oroved Denied A�proved in_Part
gequest is: _
Remarks/Camments_
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Fees:• x Total Due _.
No. of Pages Rate per Page
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ORONO ADMS�72STRATSVE OFFSCES •
1�TFORMATION DISCLOSIIKE R�4.�ST _
• � IiThZv'ESOTA GO DATA PRaiCTICES ACT '
• ggQL7ES2TER NOZ`E=
geqv.est Freauency - Privz.te Data on individuals. Afte= �°�Q
A. �
h�,Qe been supolied the aata and uf foresixfnont:nsethereafter
Qata ne�d not be disclosed to y
. � .unless �'a dispute or ac�ion is �pendiaq or zdaitional data -on
� you .has� bee� collected. y •�zCtual cos�s in �aking;
B. you may be reauirec to p y
certifyiug and/or co��iling zhe co�ies o� inforaztzOr
=equested. ; � � '
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Date of R��est:
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gequester Name- � � ��- ' � � �� , ; ��
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BgyQW �7gpgMATION TO BE FII�LE� IN BY DEPAR�N'r ON�'Y
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Subjec� o� Data �
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ge�ested By= __ Private
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=�o�at.on Requested is Classified: public
Noa-�u91ic =rotected Non-- .
Con=idential — . � � _ � Part
Denied � Fppraved n_
ge�uest is: Aoproved — — �
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gPma rks/Ca�.eats: � ` ,�. �- �
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