HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES •
INFORMATION DISCLOSURE REQUEST
• • MINNESOTA GOVERNMENT DATA PRACTICES ACT
REQUESTER NOTE:
A. Request Frequency
• - Private Data on individuals. After you
the
have been supplied the data and informed
ufo ediofsixaits earring,the
data need not be disclosed to y
. .unless :a dispute or action is pending or additional data -on
you .has been collected.
You may be required to pay actual costs in making,
B. certifying' and/or compiling the copies of information
requested. `-'573( 0 /
Date of Request: r
•
• �ieiRequester Name? �WNW,
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Address:
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zip:
Business: •
Rome Phone:
Descr
./ 'on •f o ation R- ested:. At 1
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Requester's Signature:
BELOW INFORMATION TO BE FILLED IN BY DEPARTM NT ONLY
Handled By:
Department:
Mail Phone
Request Type: In person —
Requested By: _Subject. of Data
Not Subject of Data
Information Requested is Classified:
Public Private
Non-Public
Protected Non-Public
Confidential
Denied Approved in Part
Bequest is: Approved —
Rpm*Larks/Gents:
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ed Signature: ' ; •
Authorized Page ;'' 4,
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$
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Fees:. es Rate per Page
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