HomeMy WebLinkAboutRequest for info ORONO ADMSNIS�R.ATSQE OFFICES .
INFORMATION DISCLOSURE R�4�ST
MINNESOTA Ga DATA PRACTICES ACT
�Q�S� N�� - Private Data on individual.s. ��er the
A. Request Frequency
have been supplied the data and ouf fo esixf monthsethereafter
data aeed not be disclosed tO yending or additional data �n
unless a dispute or action is p
you has been collected.
be required to pay actual costs in making,
g, you may t'r.e copies o= information
certif ying and/or compiling
requested. �
Date of Request: �
�ll�t-s�' � � �
� ���a� ���_
Requester Name s �i�Z<;� sC/� '�"T ( '- �E �Ii} /� .
� Gj�ty: /�%���
Address: l��_ �`^� `�
zip: -S^5���� a - 760 0
� 2� Business: � 7
H�e Phone: ��� �" � � -
Description of Inf°�a�'oa Re�qneste�.:
�rat�i I � S N�dt-`�/S �_��
Requester: s Signature:
BgI,OW TNBORMATZON TO BE ILLED IN BY DEPART�T ONLY
�,�Z Handled BY=
Department:
Mai? Phone
gequest Type: �_In persan —
Requested By: Subj
ec� of Data _�,Not S'�b7ect of Data
���Zi� Private
TnfoZmation Requeste3 is Classified: --
Noa-�ublic =rotected Non-Public
Confideatial —
geqnest iss �Approved
Denied Approved in Part
gemar�s/Comments:
Authorized Sigaature:
= S
x Total Due
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