HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE REQUESTS ACT
MINNESOTA GOVTDATA
REQUESTER NOTE: you
A. Request Frequency - Privateindividualitssmeaningr the
have been supplied the dataand informed of
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. a actual costs in making,
B, You may be required to pay
copies of information
certifying and/or compiling P
requested.
Date of Request: /---/3- 9,5
i
Requester Name: (�', �-, / /
Address
/X 3 Gl l.ea_ r C, City: C_ X -CIIC _�
Zip:
Home Phone:
Cf'? 5 - -6 Business:
Description of Tnformation Requested: 01'11,- C ( Se i;r .etc.
Requester' s Signature: Ab.-
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Request Type: __In person
Mail Phone.
Requested By:
Subject of DataNot Subject of Data
Tnformation Requested is Classified:
Public Private
Confidential
Non-Public Protected Non-Public
Request is: ApprovedDenied Approved in Part
Remarks/Comments:
Authorized Signature:
Fees: Pages
No. of ages Rate per Page Total Due
ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE
pREQQUESSTS ACT
MINNESOTA GOVERNMENT
REQUESTER 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.
B . You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested.
Date of Request: 12, 3o 117
Requester Name:
1 (C14."- _ !'t, (l r c) -✓2 City: V=Q cJ
Address:
Zip:
Home Phone: / (p�Z7 y �SZ, _. Business:
Description of Information Requested: l‘a
Requester' s Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Depar Lucent
Request Type: In person
Mail Phone
Requested By:
Subject of Data Not Subject of Data
Tnformation 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
No. of Pages Rate per Page