HomeMy WebLinkAboutRe: data requests ORONO ADMINIS�R.ATIVE OFFSCES
INFORMATION DISCLOSURE REQIIEST
MINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE:
A, Request Frequency - Private Data on individuals. After the
have been supplied the data and informed of its meaning,
data needdistute orsaction is pending or additional edatat�on
unless a p .
you has been collected.
B, You may be required to pay actual costs in making,
certifying and/or compiling the copies or iniormation
requested.
Date of Request: � - ��~ 7?�
Requester Name: w���'�`� ��� �
Address: ��
(�� ��� �<�'L-�-�-`� City: `�'C`��--�-e-�= .
z�p: �53"��
Home Phone� ��7 �- �U�--- Business: � �D " �� --
Description of Information �Zequ
este�: �-��>��� -��� i 5
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.a.r� � ��'/�- ',,� `a _
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4-4-L 7' 12..�.�� ��
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Rer�uester' s Signature: -
gEI,OW INFORMATION TO BE FII,I,ED IN BY DEPARTMLNT ONLY
Handled By:
Department=
Request Type:
In person Mai1 Phone
Re�uested By=
Subject o= Data Not Subject of Data
Information Requ
ested is Classified: ?ub1=� Private
Confidential Non-Public =rotected Non-Public
Request is: Approved Denied Approved in Part
RP�arks/Comments-
Authorized Signatures
_ $
Fees: X Total Due
No. of Pages Rate per Page :-
ORONO ADMIN=STR�TI� OFFI�S
=*7FORM�ITION DISGZOSUFZE R�Q�ST
jiINNESOT� Ga � DATA PRACTICES ACT
ggQIIESTER N�� - p,-i.vate Data on individuals. After you
A. Request Frecruency
t e
have be�n supplied the data and uf foresixf montnsethereafter
data need notube o�saction is pending or additional data -on
unless a disp .
you has been coZlected.
be required to pay actual costs in mak�ng►
B. You may t'r.e copies oz in=ormation
certifying and/or compiling
requested. �
Date of Re�uest:
-�1-�i�'
. �� ��1 , S��
Requester Name:
---, C.z.ty:
Address: ��c t��� �°"'�
Z i p: �'�7 S - ��7C�
c
Business :
g�e Phone: .. /
�, /vrt���i n,/1 L(,� �LVt__i'��L�'
� ormation FZeqnested: CIV���� "'" �.. �
Des cription of In.f f�(�f r`c-5,
r [+� 1 i i Gy� ��� o:,�c r�w �
C Ll C '- C � ,7.
�-�-L � G� '
ester' s Signature: 'I ��Y`�'
�e� IN BY DEPAR�NT ON�Y
Bg�,aW =NFOgMATION TO BE FII�LE�
Handled BY=
De art��t=
� � Phone
Request TyPe= —
In person Mai_.
Requested By= _Subjec�
or Data Not Subject of Data
Tnformation Reqneste3 is Classified:
�ublic _Private
NOR—�uDZ=-� ==atected Non-PuDlic
Considential —
Denied Aporoved in Yart
R�.quest is: Aporoveci —
Remar3�s/Camments-
; // -� C�
ature: `~- ' . - � .r�
Aut�orize� Sign _�
_ $
X Total Due
Pees: No. of P g Rate per Page "
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