HomeMy WebLinkAboutData request �
� City of Orono ��'p �
Information Disclosure Request
Minnesota Government Data Practices Act �� �
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Com leted b Re uester �
ester Name(L�Firs � ,^� Date of Request: � �� ��
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ail: /��� Request Type: ❑ In-Person ❑ Mail ',
V S� �Vi`Y�• IiWYY� Einul ❑ Fax �
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C,iz3� State,Zip Code:\ m r� S�
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Nou: MS § 13.05,subd 12,persons may not be required to identif'y themsalves,state a reas for,or justify a request to gnin
access to pnblic government datA.A person may be asked to provide certain idenrifying or clarifying information for the sole
purpose of facilitating access to the data.
Descrtption of th Information Requested: '
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I have read tlle info,rm ti n o this form snd understand the city may charge fees to provide the information I have requestod,
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ature
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�Com '�e� g e airtm �, �ffice Us�=. �'f,� � �� �xf� 3� �5,^` ,a r!�';.
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Department: Processed By: � �
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Method of Response: O ln-Person � Phone O Mai! Information Classifieation:
1(�Em¢il ❑ Fax �Public � Private � Non-Public
❑ Confidential O Protected Non-Public
Action: ❑ Approved Requested by:
❑ Approvad in Part(�xplain below) ❑ Subject of Dattt
❑ Denied(Explain below} ❑ Not Subject of Data
Remarks or basis for denial,include statute sectinn: Identity Verified for Private Information:
❑ Identification(DL,State TD,etc.)
❑ Compare Signatute on File
❑ Personal Knowledge
❑ Other
Note: IviS§ 13.03,subd.3,attthorizes the city to charge fees to recover cosis Co provi�e copies of data,inclucling costs
ussociated with seatcl�ing,compiling,copying,mailing or otherwise transmitting data, Prepayment is rec�uired prior to receiving
copiec of data. There is no chazge for inspection of datp or for separating not public dxYa fram public data.
Copy,charges: Z5 2/ Method ofPayment:
m'�a izX ir�ia°�> I D � x o.as � ❑ c�n r,
(#of pages) � Check -µ-�o b 6 D�
❑ (J Ix17") X 1.00 ❑ Visa
(#of pages) ❑ Master Cflrd
�'Employee Time($ ��/hr) X � hrs � .��
(only charge if over 100 pages)
❑ Other Charges(attach explanation) 12eeeived by: �_ • �
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Totfll Amount Due: $,��y Date:
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This request will be reviewed by staff and the requester will be provlded an estimate of charges prior to copying.
If mailed,rehirn form to: City oEOrono,P,O.Box G6,Crystal Bay,MN 55323
City of Orono,2750 Kelley Parkway, Orono,MN 55356
Phone: 952-249-4600 •Fax: 952-149-4G1 G • Website: www.ci.orono.mn.us
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