HomeMy WebLinkAboutrequest for info ORONO ADMSNISTRATIYE �FF=CES �
INFORMATION DISCLOnS��p��I�s �CT
- �TNESOTA GO
• gEQIIESTFK NOTE: . -
g. Request Frecuency - Private Data oa iadividuals. After yau
have been supplied the aata and informed of its meaaing, the
data need not be disclosed to Ye ding or ada t naleda at'an
.unless ��a dispute or ac�ion is �p .
you .has been collected.
g. You may be requir�ed to •pay��actual cos�s in making,
certifying and/or comailing the copies aF information
requested. •
Date of Requests
S �� �
• - i�� , � ,��
Requester Names ` v ''� �
Aaa=ess:
�z��' .��--�:-�-��1 P� c.� ��ty:
� ZiP: 5`��331 O���- 7��-��-7
Phane: ��Z, � ��Q� ���' Business: `
Hcme �
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Description of Informatioa Requ ` �
� s � . `� �
� Requester'. s Signature:
BgyOW =NgORMATION TO BE FII,LED IN BY DEPARTME�NT ONLY
Handled By:
Department=
Mail Phone
Ftequest Type� —In Persan . —
g�ested By: _
Subjec:. of Data Nat Subjec� of Data
Tnfo�ation Requ
ested is Classified: �ub1i� Private
No�-?ublic _==otected Noa-Public
Confidential — �
Denied _ ADproved in_Pa.r't
gequest is: Aporoved __ .
Remarks/Comme�ts:
Anthori.zed Signature: �
= S
Fess:• x Total Due „
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