HomeMy WebLinkAboutinfo request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCI�OSIIRE KEQIIEST
MINNESOTA GaVERNMBNT DATA PRACTICES ACT
° gEQIIESTER NOTEz
A, Request Freauency - Private Data on individuals. Af ter you
have been supplied the data and infor�ed of its meaning, the
data need not be disclosed to you f or six months thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g . You may be required to pay actual costs in making,
certifying and/or compiling the copies o= information
requested.
Date of Request: � � c� �
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Requester Names / /f
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AddreSS: �� �ii /�l li� C�- ��`�
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Zip: �E� � �.
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Description of Information Requested:
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Requester' s Signature: '�
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BELOW INFORMATION TO BE FII.LED IN BY DEPART�?NT ONLY
Departsnent:
Handled By:
In erson Mai? Phone
Request Type: P
gequested By' Subjec� of Data Not Subject of Data
Information Requested is Classified:
�ublic Private
Confidential Non-aublic -rotected Non-Public
Re�est is: Approved
Denied Aaproved in Part
Remarks/Camments:
Authorized Signature:
_ $
Fees: x Total Due
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