HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSIIRE REQDEST
MINNESOTA GOVERNr+�ENT DATA PRACTICES ACT
REQDESTER 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,
certifying and/or compiling the copies vf information
requested.
Date of Request: " { � `f ` `� �
C .._ � :
Requester Name: �� � � � ��' � �'�`"
' �`�; ��z City: I'_,: _ w�,y� C-:������
A(�dre$$: �9�\�C l_ �w� y l�:.; _�.\
Zip: �a �� �3 �
Home Phone: Business: 3 � 3 - � / j %
Description of Information Requested: ��'�, � 5 � � � �����-'t �-�����``"'�-
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Requester' s Signature: / - _ ��.L�--�
BELOW INFORMATION TO BE FILLED IN BY DEPARTMLNT ONLY
Department: Handled By:
Request Type: In person Mail Phone
Requested By: Subject of Data Not Subject of Data
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Ca�ents:
Authorized Signature:
Fees: x - $
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