HomeMy WebLinkAboutdata request ORONO ADMINISTI2ATIVE OFFICES
INFORMATION DISCLOSIIRE REQIIEST
1�+iINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE: . . .
A, Request Frequency - Private Data on individuals. Aft'er you
have been supplied the data and informed 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.
B. You may be required to pay actual costs in making,
certif ying and/or compiling the copies of inf ormation
requested. .
Date of Request: �2 ^ y � � �
Requester Na.me- � '^^
� NcLs� ..t
Adaress: � 31 �o� city: o�,'�'�
Zip:
Hame Phones ��
Z - Z o�� Business: s��
Description of Information Requ
ested: �'r`� �-�,�'" i � d .../
Requester: s Signature:
BEZOW INFORMATION TO BE FII.LED IN BY DEPARTMENT ONI,Y -
Department:
� Ha.n.dled By:
Request Type: In person MaiZ Phone
g ested B Subject vf Data Not Subject of Data
� y:
Information Requested is Classified:
Public Private
Confidential Non-Public =rotected Non-Public
Request is: APP
roved Denied Approved in Part
Re�arks/Comments:
Authorized Signature:
Fees:� X $Total Due
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