HomeMy WebLinkAboutrequest for info ORONO ADMSNISTR�TIYE OFFICES
ZIdF'pRMATION DISCLnOS�UREP�Q�=�S ACT
MINNESaTA Ga
REQIIESTER NOTE: - . -
A, Request Frequency - Private Data on individuals. After you
have been supplied the data and uffor esixfmonthsethereafter -
data need not be disclosed t� yending or additional data -on
unless a dispute or action is p
you has been collected.
B. you may be required to pay actual costs in making,
certifying and/or coucpiling the copies oi information
requested. �
Date of Requests
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Requester Name:
�Z� . � , �,�-2 c�ty: �
Address-
Zip: �JS �� � � �oo �'/
G � �� � � Business: ��
Home rhonc: �
Descriptioa of Information Requ
ested: �� �� ��
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Re+quester: s Sign
ature: �'t� 7
BELOW INFORMATION TO BE FII,LED IN BY DEPARZ'�NT ONL�
Department=
(� �2 Handled By: �` .
e: r� In person MaiZ Phone.
gequest Typ __ — --
ge�quested By=
Subject of Data � Not Subject of Data
p� aubl1� Private
Tnformation Reqnested is Classifiesi: —
Confidential Non-�ublic =rotected Non-Public
geq�uest is: d- Approve3 Denied Approved in Part
Remarks/Camments: .
. ��,,ti-.—
guthorize3 Signature: �'
Fees:� x $Total Due ._
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