HomeMy WebLinkAboutrequest for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE PR QUISSTTS ACT
MINNESOTA GOVERNMENT
•
REQUES'rr.K NOTE:
A. Request Frequency - Private Data on wed of its mea ,Afte you
have been supplied the data and informed
data need not be disclosed to you
additional
_ending or addit onal s edatat-on
actioner
unless 'a dispute or is 'p
you has been collected.
B. You may be required to pay actual costs in making,
certifying and/or compiling the copies of information
requested. J -
Date of Request: 6 117 r DO
Requester Name: C - ' •
Address:
1-{ 0 S -BY -w, City: 1-LI`1 D
Zip: '���GI —
Home Phone:
&12 , (}7 3. 24N`D Business-
Ve ; S � c---1,._,Description of Information Requested: k
' 0 (3)7U-91(-*` -
Requester's Signature: J
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department:
Mail Phone
Request Type: —In person —`' —
Subjec� of Data Not Subject of Data
Requested By:
Information Requested is Classified: Public _Private
Confidential
Non-Public Protected Non-Public
Approved Denied Approved in_-
Part
Request is: —
Remarks/Comments:
Authorized Signature: ' /JLu-�.��
/
Fees:. xTotal Due
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