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City of Orono 7,4-07) <br /> Information Disclosure Request <br /> Minnesota Government Data Practices Act 5� e <br /> Completed by que ter <br /> Re�ques r ame( first I): Date of Request: 2 <br /> Request Type: ❑ In-Person 0 Mail <br /> Ernie_ <br /> L ,C/7.1 )v J4`r, , u-` 0 Email 0 Fax <br /> Street6, <br /> Addiss: n /� /�.2 r�J Phone Numb `O '�e �—U Q ��•. <br /> City,State,Zip Code: `7–�7C Signature• <br /> L�,� L,i.� 141/V57 '3' <br /> Note: MS § 13.05,subd. 12,persons may not be required to identify themselves,state a reason for,or just a - ._- -to gain <br /> access to public government data.A person may be asked to provide certain identifying or clarifying information for the sole <br /> purpose of facilitating access to the data. <br /> Description of the Information Requested: / <br /> S'V <br /> l�e � <br /> L� � w1S / pl, z �. '� eW � v <br /> 6.v y, �,�-� ter_ /7 D-4 <br /> I ha - read t e informatiI ,•-and understand the city may charge fees to provide the information I have requested. <br /> — ` <br /> Signa e <br /> Completed by Department—Office Use Only °- <br /> Department: Processed By: <br /> Method of Response: 0 In-Person 0 Phone 0 Mail Information Classification: <br /> 0 Email 0 Fax 0 Public 0 Private 0 Non-Public <br /> ❑ Confidential 0 Protected Non-Public <br /> Action: 0 Approved Requested by: <br /> O Approved in Part(Explain below) 0 Subject of Data <br /> O Denied(Explain below) 0 Not Subject of Data <br /> Remarks or basis for denial,include statute section: Identity Verified for Private Information: <br /> ❑ Identification(DL, State ID,etc.) <br /> ❑ Compare Signature on File <br /> ❑ Personal Knowledge <br /> ❑ Other <br /> Note: MS§ 13.03,subd.3,authorizes the city to charge fees to recover costs to provide copies of data,including costs <br /> associated with searching,compiling,copying,mailing or otherwise transmitting data. Prepayment is required prior to receiving <br /> copies of data. There is no charge for inspection of data or for separating not public data from public data. <br /> Copy charges: Method of Payment: <br /> ❑ (8'/A x 11/14") X 0.25 ❑ Cash <br /> (#of pages) ❑ Check <br /> O (11x17") X 1.00 0 Visa <br /> (#of pages) 0 Master Card <br /> ❑ Employee Time($ /hr) X hrs <br /> (only charge if over 100 pages) <br /> ❑ Other Charges(attach explanation) Received by: <br /> Total Amount Due: $ Date: <br /> This request will be reviewed by staff and the requester will be provided an estimate of charges prior to copying. <br /> If mailed,return form to: City of Orono,P.O.Box 66,Crystal Bay,MN 55323 <br /> City of Orono, 2750 Kelley Parkway, Orono, MN 55356 <br /> Phone: 952-249-4600 •Fax: 952-249-4616 • Website: www.ci.orono.mn.us <br />