HomeMy WebLinkAboutrequest for info ORONO ADM=27ISTRATSYE 0�=�S -
INFORMATION DISCLOnS��PR�I�S gCT
• � tiI3�NESOTA GO ,
• ggQUESTEFZ NO�E: .
A. gecruest Frequency - P=ivate Data on individuals. �=te'-' �°�o
have been supplied the data and uffo�sixfnon�.:�set'-���reafter �
data ueed not be disclosed t� yendina or additional data -on
� .unless `a dispute or action is �p �
you .has been coll.ected. �
H, you may be reauir�ec to pay ��actual costs in �aking,
certifying and/or compiling zhe co�ies or in�orraatior
requested. Q / •
Date of Requ
est: � r �
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Requester N�e- /J?
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Address: ih J —'
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Description of Information Reuuested:.
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� gecruester'. s Signature:
BgyOW =LTFORMF,TION TO BE FII,LF.I] IN BY DEPAR �- � OhZY
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gequest Type� ✓ In persan . —
Subjec�' of Data �� Not Subjec� o= Data
gequested $y= � — `
✓ �ui�Iic Private
�fo�mat�on Requested is Classified: —
Non-?ublic -rotected Non-Public
Con=idential . �
Denied � ADprovec =n_Paz�
geflraest is: ✓ Aporc�ed — �
Re�sarks�Casam.ents-
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Authorize3 Sign.atare: �
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