HomeMy WebLinkAboutRe: Info request ORONO ADMINISTI2ATIVE OFFICBS
INFOItMATION DISGLOSURE REQII$ST �
MINI�TESOTA GOVERrIl�LJT 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 need 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 may be required to pay actual costs in making,
certif ying and/or compiling the copies of inf ormation
requested.
Date of Request: " `�
Requester Name: � ����
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Address: ��� � - City:
Zip: �����
Ha�e Phone: y7� 9`7� Busines : 7�ir �o
D ript' n of I ormation Requested: �� L- �
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Reqnester: s Signature:
BELOW INFORMATION TO BE II.I�ED I DEPARTMLNT ONLY
Department: Ha.ndled By:
Request Type: In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Info=mation Reqnested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Co�ments:
Authorized Signature:
Fees:� x = $
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