HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSIIRE REQUEST
MINNESOTA Ga DATA PRACTICES ACT
REQIIESTER NOTE:
A. Request Frequency - Private Data on individuals. After 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.
ay actual costs in making,
B. You may be required to p
certifying and/or compiling the copies of information
requested.
Date of Request:
Requester Name:
Address: �-
� �t y i'�Lcity: �. .�
-%
zip: ss3 6 -
Home Phone: Business:
Description of Information Requested:
Requester' s Signature:
BELOW INFORMATION To BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Request Type:
In person Mail Phone
Requested B Subject of Data Not Subject of Data
equ Y=
Information Requested is Classified: Public Private
Confidential Non-Public Protected Non-Public
P
Request is:
Approved Denied Approved in Part
Remarks/Comments:
Authorized Signature:
Fees:. x $Total Due
No. of Pages Rate per Page