HomeMy WebLinkAboutRE: request for data r �`
OROLIO ADMINISTF�TZVE ��S�S
rNFORMATION DISCI�OSI7RE RE4�ST
IS.INNESOT� GO DATA PRACTSCES ACT .
REQIIESTER N��= on individual.s. �f t�- Y°u �
A, Request Frecruency - Private Data � tne
have been supolied,the osed to youffo esixfm°ntnsethereafter
data need not be d_sc1}, e��ing or additional data -on
unless a dispute or ac�_on is p
you has been coZlected. � �c�L� ? costs in making,
g , You may be requ'-'-"Pd to p�- �. iniormation
certifying and/or compiling �.r.e copies oz
requested. �
Date of Re�u
est s ��'3/��
� �
Requester N�e= O/w�>
S�� L�c�� /�i� �'-ty:
p,ddress: �
Zip:
Business:
gome Phone:
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Description of Informati°n Reuuested:
�
Re�ester' s Signature=
BgyOW INgORMATION TO BE FII.L�D IN B DEPARTM�NT ONLY
Handle3 By=
Department=
_n persan
Mai? Phone
Ftequest T��pe: —
Not Subject of Data
Subjec� or Data —
Re�uested By= — ,
_�Z�� pr�vate
Information Requested is Classified=
Nor.-�,sb l;.c
=rotected Nan-Punlic
Conf idential
geq-uest is: Aporoved
Denied Approved in Part
Remarks/Ca��ts:
Authorize3 Signatzire:
_ $
X Total Due
Fees: eS Rate per Yage •:
No. o= Pag
� ,�
�(�r � .�
� Susan J. Kreye � �
� � t�RI �
� ��ecutive Sales Associate
�dina/Southdale
Office ��
;550 France Avenue South ��,R,,
Edin�,MN 55435
Bus: (612)844-6019 ;������W
Res: (612)944-7528
Fax: (612)844-6099 �'°��