HomeMy WebLinkAboutdata request ORONO ADMINISTR�TNE OFFICES
INFORM�TION DISCLOSIIRE 12EQIIEST
MSNNESOTA Ga 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 end ng or aaa ti nal edatat�on
unless a dispute or action is p
you has been collected. �
g, You may be required to pay actual costs in making,
certif ying and/or compiling the copies oi inf ormation
requested. �
- Date of Request: �����
Requester Name: ���A �A �
�aaress:
a��g �zty: L�U ��L
Zip-
Home Phone: " 1� � � �B ° `� Busine s s:
• Description of Information Requested:
.
,
Requester: s Signature:
BELOW INFORMATION E FI7�LED IN BY DEPARTMLNT ONLY
Depart�ent s
Ha.adled By s
Request Type:
In person Mai1 Phone
ested B Subject of Data Not Subject of Data
Requ Y=
Inf ormation Requ
ested is Classified: �ublic Private
Confidential _Non-�ublic _rotected Non-Public
Denied Approved in Part
gequest is: Approved ,_._
Remarks/Com�ments:
Authorized Signature:
_ $
Fees:� X Total Due
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