HomeMy WebLinkAboutRe: request for info ORONO ADMTNSS�RATSY�' OFFSCES �
1�7FORMATION DISCLOSURE RESZ�ST _
• � �NN'ESOTA Ga DATA PR�CTICES ACT ,
• gpQUESTER NOZ`E=
A. gequest Frequency - P?'iv�.te D�t� on individuals. ��ter th�
have been supplied the aata and ouf Qo esixf noncnse hereafter -
data need not be disclosed to y
. .unless 'a dispute or action is -pendiaq or additional data -on
you .has been col.Zected. _
. you may be reauir�ec to pay��actuzl cos�s in making,
B and%or compiling zhe cogies o� in=oraztiOr
certif ying
requested. I '
Date of Requ
est: �� � /
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Requester Name:
N� City:
p,r3dress: �
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�� j �� Business:
g�e Phone:
Descrip'�on of �O�a�'On Retru
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� Recraester'. s Signature:
Bg�,OW =27gORMATION TO BE FYI.I�ED IH BY DEPARTl'�=NT ON�Y
.� 4� � $andled sY=
D ep art-�.ent: �'
MaiZ Phone
geqv.est Type= ��—In pe'-"son . — —
Subj a= Dzt� � Not Sub�
ec� o= Data
gequested By= — ec� —
:/ �uDlic _Pri.vate
T��o�at.on Requested is Classified: —
=rotected Non-Publ.ic
Nan-?ublic — .
Conf idential. — � Pa�.
Denied � Anproved n_ _
gecmest is: '� Atioroved — �
Re�arks�C��ts:
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Autb.or�-ze3 Signat�re: � .
C �� _ $
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