HomeMy WebLinkAboutrequest for info .
ORONO ADMINISTRATIVE OFFICES •
1"NF'ORMATION DISCLOSURE PR CISC'SS ACT
• • MINNESOTA GOVERNMENT
• REQUESTER NOTE:
you
A. Request Frequency - Private Data on individuals. After tou
have been supplied the data and informed of�its meaning,onthsthereaftere
data need not be disclosed to yendina or additional data -on
ou for six Bless .a dispute or action isp
•
you .has been collected. •
You may be required to pay-actual costs in making,
B. the copies of information
certifying and/or compiling
requested.
573/
O
Date of Request:
Requester Name:. A�..�. -. 1111111.
(.0
• __Ale' ' , City: )A6
Address: •
zip: •
Business:
Home Phone:
If o ation R- 1ested:. 1 _=
Descr ' ay on "
. f" f .41 f / -.4g.t
Requester's Signature:
BELOW INFORMATION TO BE FITTED IN BY DEPARTMENT ONLY
Handled By:
Department:
Mail Phone
Bequest Type: In person —
Subject of Data
Not Subject of Data
Requested By: —
Information Requested is Classified:
Public Private
Non-Public Protected Non-Public
_Confidential in pat
Request is: Approved
Denied Approved
Remarks/Coamaents:
di Q ---�/;ems-..---'zed Signature: f / •
,70'''
Authorized
Fees:. x Total Due
No. of Pages Rate per Page
3 0, &tic&-oc.
iL 55 ha %ns
3 2 3-7 awe-0 � . ✓
3 0 3,5 a4-e--c) gl-(7S foe /
1- ,q 10
ei
/ 0 Pce
( $ S
/ 5 0,-„,„ fce
11 0 acuntz-e, s
PO
;Lo a a-c-4
Ced ZaLz krti
317s— /0/ „.C/c7eue,
i u B�a� P�T.DA_
i � � Na