HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFOI2MATION DISGLOSIIRE REQIIEST
MINNESOTA GOVERI�Il�SIdT DATA PRACTICES ACT
gEQDESTER NOTE: � . . .
p,, Request Frequency - Private Data on individuals. After you
have been supplied the data and infornted of its meaning, the
data need not be disclosed to you for six months thereafter
unless a dispute or action is pending or additional data -on
you has been collected.
g. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested. .
Date of Request: Z
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Requester Name: - �
Address: � Z 3 e•v•� City: �1P4�
Zip: .�.�y//
Home Phone- .S�z-�- -L� �" Business: �A��
Description of Information Requested: i ' �� � U
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Regnester'. s Signature:
BELOW INFORMATION TO BE IN DEPARZ'MENT ONLY
Department: Han.dled By:
Request Type: In person Mail Phone.
R ested B Subject of Data Not Subject of Data
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Information Requested is Classified:
Public Private
Confidential Non-Public Protected Non-Public
Reqnest is: Approved Denied Approved in Part
Re�arks/Co�mments:
Authorized Signature:
Fees:� X $Total Due
No. of Pages Rate per page •-
ORONO ADMSNISTRAT=VE OFFSCES
INFORMATION DISCLOSIIRE REQUEST
I�SINNESOTA 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 neaddistute orsaction is pending or add tional edatat-on
unless P .
you has been collected.
g, You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of Request: � � ' "�� � �
Requester Name- �� ���
�� �2,�-,� �KC���IC��-
Address: %K�-� ��' _ CitY:
Zip: �" ' j� � Z��Z
_ ��-�- 2. � �Z Business: ��� `
Home Phone�
Description of Information Kequ
ested: ��)�'�� �� ' � ���
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Requester' s Signature: %
BELOW INFORMATION `?�O BE FII,I,ED IN BY DEPAR22+g?NT ONLY
��s Z Ha.ndled By: ��'•
D epart�ent:
Request Type: �_
In person Mai1 Phone
R ested B Subject of Data �_Not Subject of Data
eq�u Y=
Inf orm.ation Requ
ested is Classified: �_�ublic Private
Confidential Non-?ubZi� =rotected Non-Public
Request is:
Approved Denied Approved in Part
Re�arks/Comments:
� ^`
Authorized Signature: - `�-�`�'^---�
_ $
Fe�s: X Total Due
No. of Pages Rate per Page ..