HomeMy WebLinkAboutinfo request ORONO ADMINISTRATIVE OFFICES
INFORMATION DISGZOSDRE REQIIEST
MINNESOTA 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 nea distute orsaction is pending vr aaa�t�nal 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 o= in=ormation
requested.
Date of Request: �
�� - � - � 1
, ` I '� (V �Ls��
Requester Name:
Addre s s: 3��' 1-��- S�{"ov�E �I��� City: v t�"'--�"
zip: �
Home Phone:
��Z.- 20��}- Business : ��'��=
Description of Information Requ
ested: S��"-"` `� ��' ol �
�/p�,.�b.r��- 6 U�v�.T 1 0.„�
_ �/Re�uester' s Signature:
gELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT ONLY
D epartsnent:
Handled By:
Request Type:
In person Mai1 Phone
gequested By- Subject of Data Not Subject of Data
Information Requested is Classified:
�ublic Private
Confidential Non-Aublic =rotected Non-Public
ges3uest is: Approved Denied Approved in Part
Remarks/CQ��ts:
Authorized Signature:
_ $
Fees:� X Total Due
No, of Pages Rate per Page ..
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