HomeMy WebLinkAboutrequest for info ORONO ADMINSS�RATSVE OFFSCES
INF`ORMATION DISCI�OSIIRE RE4�ST
I�4SNI�TESOTA Ga DATA PR�CTICES ACT
gEQIIES�FjR NOTE= -
A. Ftequest Frequency - Private Data on individuals. After y°u
have been supplied the data and informed of its meaning, the
data need nvt be disclosed to you for six months thereafter
unless a dispute or ac�ion is pending or additional data -on
you has been collected. �
B, you ivay be reauired to pay actual costs in making,
certif ying and/or compiling the co�ies oi iniormation
requested. -
Date of Request: �L '�
' �r y� � f.�
Requester Name= � �
city: u'�'fi�
Address: �-"� ' ��--�
zip: F�3`L1
, , � �v��...,�.���?'
Z`� Phone= �� ����-i Business:—( � � �w"Z-�- �"���"
Description of Information Reuuested:
.�
� ,
Requester'. s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPART2�NT ONLY
Handled BY:
D ep ar-tment=
Mail Phone
ge�quest Type= In persan —
Subjec" of Data Not Subje�� or Data
gequeste3 By= `
?ui�Iic Private
Information Re�quested is Classified: —
NaII-�ubZ�� =rotected Non-Public
Cons"idential
Approved Denied P_pproved in_Fart
gequest is: _ —
Remarks/Cau�ents:
Au-thorized Sign.ature:
= S
Fees:� X Total Due __
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