HomeMy WebLinkAboutRe: request for info ORONO ADMINISTRATIVE OFFICES
INFORMATION DISCLOSURE
PR�AC PRACTICES 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 Yu for siamonths
d ti nal edata -on
reafter
unless a dispute or action is pending or
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: (- • n G1
Requester Name: A ' k- A1-- OA)
Address: 100 o Q(t.c—lases
City: ___Q171.2152___
Zip:
Home Phone:
22. 2'1 Business:
� "1
Description of Information Requested:
, 1 1 —Or
Requesters Signature: 111111MNIEF
BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY
Handled By:
Department=
Request Type: In person
Mail Phone.
Requested By:
Subject of Data Not Subject of Data
Information Requested is Classified: Public —Private
Confidential
Non-Public Protected Non-Public
Approved Denied Approved in Part
Request is: PP —
Remarks/Comments:
Authorized Signature:
Fees: x Total Due
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