HomeMy WebLinkAboutrequest for info ORONO ADMSNISTRAT2VE �FFICES
=3�7E'ORMATION DISCL�SIIRE R�Q�ST
� IS2NNESOTA Gati�� DATA PR�CTICES ACT
• g�QIIES�ER NO�Es -
A. Reauest Freauency - Private Data on individuals. Afte= Y°u
have been supplied the data and informed of its meaning, the
data need not be disclose3 to �'eIIdina or �ddit onal edatat-on
�unless `a dispute or ac..ion is p
you .has been col.Iected.
H, you may be reauired to pay �actual costs in �aking�
certifying aad%or compiling the copies o= infor��tiOn
requested. -
Date af Request: b b �m0
Requester Name- � .
Address: �Q w �''(1�lLOcS� �� V� ity' ��
��� �-� — ,Y'�e�-a�'�`" -�
Zip= �
e Phone: lol� �� � 6� Business. �C� �-•��- � ,
$� � � �
Description of Information Reffuested:
? �'�/_5 ,i�-���� �4�'.�-� �
Y . �
gequester'. s Signature: �
BEI�OW SNFOR�`SATION TO BE FII�LED BY DEPA�ZTMSNT ONLY
sanaled By=
Depar�ent=
Mai1. Phone
ge�aest Type= _In Pe=sc^. . —
gequested By= _
Subjec� o= Data Not Sunject os" Data
ested is Classified= �u�Ii� Private
Tnfozmation Reqa —
Conf idential Non-?�Zic
=rotected Non-Public
Aoproved Denied Anproved in_Part
g�quest is: _,_ —
Remarks/Ca�ents:
� �+
! , , ,t� �•fr-f'-�-n'-�,q l � Q ,/�7
Antb.orized Signa
tBre: 1,��� ' ! (J u �.���., v���-�..
= S
Fees:• X Total Due ..
No. of Pages Rate pe= Fage