HomeMy WebLinkAboutRE: request for info ORONO ADMINISTRATIVE �FFI�S
INFORMATION DISt�OSiTRE REQIIEST
I�+iINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE: •
A, Request Frecuency - P�ivate Data on individua?s. After you
have been supplied the data and informed of its meaning, the
data needanstube oTsaction is pendina or add tional edatat�on
unless a p .
you has been collected.
B, You mav be reQuired to pay actual costs in making,
certifying and/or compiling the copies oz inior�atior-
requested.
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Date of Request: ',� r'
� � .,r,t" �17 T ' � �i''Y�. ry� �.� ;�✓`f� ,`rw..a:.�
Requester
Name: !- �,j-�. �_ �,�,�- -1';
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Address: ��� . ���' �, �y " �; ����� s r � :,,�. City: r� � . w�
Zip� " % r' , _
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Business : ��;, ;"- _. �_.; � �
Description of Information Requ
ested: l� � ,� �1 � �f - r',�� j`�� ; ' � ,
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Requester' s Signature: �. - _
BgyaW INgORMATION TO BE FSI,I,ED IN BY DEPARTMLNT ONLY
Handled By:
Department:
In erson Mai? Phone
Request Types P
R ested B Subject or" Data Not Subject of Data
� y:
Information Reuuested is Classified:
?ublic Private
Confidential Non-PubZi� =rotected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments-
Authorized Signature:
_ $
Fees:� X Total Due
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