HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSIIRE REQIIEST
MINNESOTA GOVERNMENT 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,
certifying and/or compiling the copies of information
requested.
Date of Request: � �/ /
Requester Name: ��f�> �<;,�ir��
Address: � 7 n,�;3 6�3 � �� '�� 1} L�`17 City:
z ip: -�� �S��v`(, �
Home Phone: S�G 3 5���' i susiness: �f �S^ Z �{ l /
Description of Information Requested: _�� .r�-. �� ` �
/�o C� ,���-�- ��t.-���
°� �� �P ��i,e�. -�-��
Requester' s Signature: ,�_._.-�
BEIAW INFORI�IATION TO BB FILLED IN BY DEPARTMENT 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/Comments:
Authorized Signature:
Fees: x = $
No. of Pages Rate per Page Total Due �