HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATIVE �FFI�S
INFORMATION DISCI,OSU�E REQIIEST
MINNESOTA Ga 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 ne�d notube orsaction is pending or add ti nal edata -on
unless a disp .
you has been collected.
B, you may be reguired to pay actual costs in making,
certifying and/or compiling the copies of insormation
requested.
Date of Request: � �� ��
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Requester Name: t � /�- �� � � � ` / /
/ ( � � �,.� G �'� city: Gi/�� ���
Address: � .� (� �
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Home Phones
Business: % ��G% ����
Description of Information Requ
este�: � ��� -��(,� — ����� �,��
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Requester' s Signature: � � � ��`�
BEZ�OW INFORMATION TO B FILLED IN BY DEPARTML'NT ONLY
Handled Bys
Department:
Request Type:
In person Mai1 Phone
g ested B Subject oz Data Not Subject of Data
� y:
Information Requested is Cl�ssified:
Public Private
Confidential Non-?ublic =rotected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments:
Authorized Signatnre:
_ $
Fe�s: x Total Due
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