HomeMy WebLinkAboutRe: request for info •
ORONO ADMINISTRATIVE OFFICES •
INFORMATION DISCLOSURE REQUEST
• MINNESOTA GOVERNMMNT DATA PRACTICES ACT
REQUESTER NOTE:
r yo
A. Request Frequency - Private Data on indi i ditss. Afte you
have been supplied the data and ouffored ofor six months thereafter -
data need not be disclosed to yendinQ or additional data -on
.unless :'a dispute or action is -p
you .has~ been. collected.
'
in
You may be required to pay-actual
c so s f in making,
certifying
B. and/or compiling the co_
rmation
requested. `6/�� 0
Date of Request: (
•
•
411111111" ,
Requester Name . n
��-, 1 , City: a v G�i2p�
Address: (� L'�� �.� �J
zip:
Business: •
Home Phone:
Descr ' ./ 'on •f o ation R- - ested:.
Requester'.s Signature:
BELOW INFORMATION TO BE FILLED
IN BY DEPARTMENT ONLY
Handled By:
Department=
Mail Phone
Request Type: In person —
Requested By: _Subject of Data
Not Subject of Data
Information Requested is Classified:
PublicPrivate
Non-Public protected Non-Public
Confidential ____
Denied Aporoved in_Far v
Request is: Approved —
Remarks/Comments:
• , K_ /
Authorized Signature: ,' •
pees:. ax Total Due
No. of Pges Rate per Page
• 4
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