HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUEST
MINNESOTA GoV=U4ENT DATA PRACTICES ACT
REQUESTER NOTE:
A. Request Frequency - Private Data on individuals. After you
have been supplied the data and informed of its meaning, the
er
data need dispute or
orsaction is pending or additional sed to you for six months edatat
unless a disp -on
you has been collected.
B . You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested. )
Date of Request:
Requester Name:. �L_��O r _ _
Address: o r' (�t t t t
City:
zip:
Home Phone: e 7 S - C'7C Business :
� Z
Description of Information Requested:
C1 T
r=v
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Requester' s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Z Handled By:
Department:
Request Type=
In person Mail Phone
RequestedY= `
B Subjec- of Data Not Subject of Data
Information Requested is Classified: public Private
Confidential
Non-Public protected Non-Public
Request is: Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature:
_ $
Fees: x Total Due
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