HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATN� ��=�S �
I3`TFORMATION DSSG.LOSURE R.L'4DEST
. �SNNESaTA Ga DATA PR�CTIGES ACT
' gEQUES�F�Z NOTE: •
A. Recruest Frequency - Private Datinfor�ed1 of itssmeaning, the
ha.ve been supplied the aata and ou for si.x mont:ns thereafter �
data rzeed not be disclosed to y
�unless `a dispute or ac�ion is pending or additional data -on
you .has been collected.
B, you �ay be reauirec to pay actual costs in making,
certif ying and/or compiling the copies o� inf ora.ati.on-
requested. -
Date of Request: � '� �� �
� - '" � /•, ; -, ;
Requester Name- - 0 r l � ( 4 �c .
� City: �' � '���� �
Address: > �� � ( �,� �7 v'� e u ( ��
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Z iP: � � `�
gome Phone: Cf � � - �( U � S Business:
Description of Information FZecruested. - C°�t x�r�' � T�x �
j�c c b ���-� �-
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Reuuester`. s Signature: �J �•
BELOW SNFORMATION TO BE FII,I,ID I'•Z BY DEPARTMENT ONLY
Q� 2 HandlecZ BY z
Department: —
oLIn persan
Mai1 Phone
gequest Type= .
gequested By= Subjec� of Data
� Not Sut�ject of Data
�ublic Private
Tn-Formation Requested is Classified: �- —
Non-?ubZi� =ratected Non-Public
Conf idential _
Q��ipproved Denied Approved in_Part
gequest is: —
Re�.arks/Ca�mests:
An�tb.orize3 Signat�re:
_ $
Fees:. X Total Due ..
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