HomeMy WebLinkAboutRe: Request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSDRE REQDEST
MINNESOTA GaVERPIlK.BNT DATA PRACTICES ACT
gEQIIESTER NOTE:
A, Request Frequency - Private Data on individuals. After the
have been supplied the data and informed of its meaning,
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.
B, you may be required to pay actual costs in making,
certif ying and/or compiling the copies ot information
requested.
Date of Request: 2 \ `�� �
Requester Name: �1���.Y� � ����C�h �-='-,-� "� `, �
Address: �2� �J•`nC-e �1�5 �"�'�r� City: �� \Y��1
zip- ����{�S
Home Phone• �� 1 ' ��� � Busines s: ��S�"���
Description of Information Requested:
".� . _ �V L l� c�`� ` `(\�C:•�V✓�C�: �
, �,1��� ��c�,� � ��
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Requester' s Signature:
BEI�OW INFORMATION TO BE FILLED IN BY DEPART�:NT ONLY
Depart�.ent- Handled By:
Request Type: In person Mail Phone
R ested B Subject of Data Not Subject of Data
� y:
Info=mation Requested is Classified:
Public Private
Confidential Non-Public Protected Non-Public
Request is: APP
roved Denied Approved in Part
Remarks/Co�ments:
Authorized Signature: �
Fees:. X $Total Due
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