HomeMy WebLinkAboutdata request ORONO ADMINIS�RATSYE ��=�S �
2NFORMATION D=SCLOnS�II�PR�I�S gCT
� I4SNNESOTA Ga ,
• gBQUES�ER NOTE: .
A. gequest Freque�cy - Private Data on individuals. A�teT �°�Q
have been supolied the data and ouf f=�sixfmon�sethereafter �
data need not be disclosed to yending or additional data -on
-unless .�a dispute or ac�ion is p �
you .has been collected.
B , you may be reauirec to pay �actual costs in making,
certifying and%or coutpiling the copies or in=oraati.or
requested. •
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Date of Request= �/
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Requester Name� � ' ' /
� City: � �
AdB.ress:
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Requester`. s Signature:
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BgyOW INFORMATION TO BE FIT�LED IN BY DEPARTM�� OZ�LY ��
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D ep artment: f C C�-�l'�'.�-�
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gequest Type- —In persan . -- -�--
gequested By=
�/ Subjec:. v= Datz Not Subje�� or Dzta
�uDlic _Private
�offiati.on Req�uested is Classified= ,_
Non-�ubl.ic
:rotected Nan-publz�
Considential —
— Approved in Par�
Aporoved Denied ,__ -- -
Reu-uest is: __ —
Re�arks/Caiuments-
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Ant�iorized Signatare: ,
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Fees:• X Totzl Due .,
No. of Pages Rate per Page
ORONO ADMSNSSTRATSYE �F�SCES �
2NFOFtMATION DISCLOUS�UREPR�4�I�S gCT
• � MSNNESOTA Ga ,
• gEQUES� NOZ`E: .
A. geques-t Frequency - Private Data on 3..ndividuals. �ter th�
have been suppliea ,�Zosed to youf foresi.Xf mon-cnse hereafter •
data n.eed not be dz
. � .unless `a dispute or action is �pending or zdaitional data -on
you .has beein collected.
you �ay be reauir�ed to pay��actual cos�s in �aking:
B . zhe cogies or inf oraatior
certifying and/or com�iling
requested. � •
Date of Request:
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Requester Name= \ �
�D � �0� %\ „ City: � . Cl�'t--��
A.aa.=ess:
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ormation Ret_ruested:� �
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� Reuueste.r'. s Signature:
B�,yQW =NgORMATION TO BE FIT�LID IN BY DEPART�''NT O2T�'Y
s�.alea sy:
D ep art�.ent:
MaiZ Phone
gequest Type3 —In pe=son . — —
gequested By= —
Subjec� o= Data Not SuDje�� o= Dzta
=�offiat:.on Reqaested is Classifie�d:
�ublic =Private
Naz-?ublic
=rotected Nan-Public
� � Confidential — . � ;n pat
Denied � _ ADproved _- -
gecrues�t is: Aooroved — �— �
Rem.arks/Camments:
Anthon-zed Signatare: -
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Fees:• X Total Due .,
No. of Pages R�te per Page
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