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Amount: $ RECEIPT:
Initials
REQIIEST FOR REPRINT OF OVERSIZED DOCUMENTS OR
BIIILDING PLANS AND BLIIE PRINTS
Date of Request: � " �l� ' ��2
�
Name: ,� ' u-� -tT/i�� �--�r Phone: ��� �" Z��-�
work)
Address: ,�2/ l���i ���7�,.` j %�r` � � %� �7
home
city: L� ;� j L-=� �-C
State: /� /`' Zip: > > 3 J (�
Description of document( s ) to be reprinted: C> C> �/ �'� �`� � t'``��
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CHARGES: (the followi g charges are subject to rate changes )
Oversize � Documents From Microfilm
The charge for suc reprints is 2.�0 each. There is an
additional $10 . 00 charge f pickup and delivery.
Building Pla�s, an� 'Blueprints
The charge for such reprint9•� is $0.12 per square foot with
no minimum charge. Reprints will be made at: Engineering Repro
Inc., 13700 lst Ave N, Plymo�`th, MN 55441. Telephone: 473-2902.
All charges must be paid at the time of the request, and are
non-refundable. Rec�ests will require a minimum of three ( 3)
working days to fi�l, and must be picked up at the City offices
unless other ar angements have been made. If prints are
delivered and ' cked up by courier service, the charge for such
service is to e paid by requestor.
Si at re
1
ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSIIRE REQIIEST
MINNESOTA GOVERNMENT 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:
Requester Name:
Address: City:
Zip:
Home Phone: Business:
Description of Information Requested:
Requester' s Signature:
BELOW INFORMATION TO BE FILI,ED IN BY DEPARTM�?NT ONLY
Department: ��j G Z 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: _�X Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature: -� �-��,-
� � ��
' <,� c _ $ � _ t_.
Fees:� ��:, X � � _
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