HomeMy WebLinkAboutData request ORONO ADMINISTRATIVE OFFSCES �
INFORMATION DISCLOSDRE RE4IIEST
. �NNESpTA Ga DATA PR�iCTICES �.CT
• gEQIIES�ER NOTEt �
A. gequest Frequency - Private Datinform d ofd itssmeaning, the
have been supplied the aata and
data aeed not be disclosed to Yeuding or ada t onaledatat-on
�unless 'a dispute or action is p
you .has been col.Iected.
B. you �ay I�e requirec to pay actual cvs�s in making�
certifying and/or compiling the copies o= information
requested. •
Date of Request. -� �v
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Name s ��� -�� �G�,
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p�ddress: ��C�C� , �� `
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Description of Information Ftec�uested: , _
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� gequester'. s Signature: �� � �''c ` , "
BgyOW INFOR��iATION TO BE � "�LED IN BY DEPAR�NT OI�LY
��' 2 Handled By� �/ (-?
Depart�.ent=
ge�uest Typez D��_In Person .
Mai1 Phone
gequested By=
Subjec� o= Data � Not Su°7ec� of Data
��IzC private
]'nformation Requested is Classified: �
Nan-�ubZi� =rotected Non-Public
Conf idential _
Approved Denied Aaproved in_Par't
gequest is: �`' —
Remarks/Comrments:
Anthorize3 Signa
ture: �St. .__..
_ $
Fees:� x Total Due ._
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