HomeMy WebLinkAboutData request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQIIEST
MINNESOTA GO�i�RN�NT DATA PRACTICES ACT
REQIIESTER 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 months thereafter
unless a dispute or action is pending or additional data on
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of Request:��-r�� �-� =�
Requester Name: ���-�� � � �-�``"-``"'"`�
Addre s s: :� '/C/ i��--�-C� �-rc-�_- City: ,���y,,��-,-��_�
Zip: j � � �/�
Home Phone: � � 3 -�f �/ Business: �� �j� �� 3 G J.� �
Description of Information Requested: ��--� �y�^-�-��y
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Requester' s Signature: ,%�'���,��' '�-�����-`�'-���
BELOW INFORMATION TO BE FILLED IN BY DEPARTMF?NT ONLY
Department: Handled By:
Request Type: In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Camments:
Authorized Signature:
Fees: x = $
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