HomeMy WebLinkAboutinfo request ORONO ADMSNISTRATNE OFFSCES
INFORMATION DISCLOnS��P���S ACT
�S27NESOTA GO . -
�Q�S� N� - Private Data on individuals. After you
A, Request Frequency
have been supplied the data and informed of its meaning, t e
data ne�d 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 inay be required to pay actual costs in making,
certif ying and/or compiling the copies oi inf ormation
requested. �
Date of Request: � �
� ��1 ����_
gequester Name: 2. � S \l��� ��� �j/�
) Z� , '��,(1,�, � �,� city:
pyddress• (�
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� ested: �� �� ��
Descriptian of Information Re�qu
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a ��J �� r(
Requester: s Sign
ature: �'�v 7
BELOW INFORM�TION TO BE FII�LED IN BY DEPARTI�E?NT OPTL�
(� �2 Haadled By: d ` '
Depart�ent=
Mail. Phone.
gequest Type= 0` In person —
Subject vf Data � Nvt Subject of Data
Requested By= — —
Tnformation ge�qaested is Classified:
� ��Ii� private
Noa-Public =rotected Non-Public
Confidential _
gequest is: d-Approved Denied Approned in Part
—
Remarks/Coa�ments: •
� ���.N—
Authorized Sigaature: �'
_ $
Fess:• x Total Due ._
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