Laserfiche WebLink
ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQIIES'lEX NOTE: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, <br /> the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data -on <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Request: - ( 2 - c-t? <br /> Requester Name: ( u- sJ -ti' 6 L-`'`'"t) w r f <br /> �- L ov 4A/Lez <br /> Address: ' 610 C <br /> City: 1,. H � >> l- t 12_t .-- <br /> �� <br /> Zip: '7( I G / <br /> Home Phone: 66ct - (25 ( Business: 5 5 ( 7 z7(-f <br /> Description of Information Requested: <br /> —to L <br /> Requester's Signature: <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Request Type: <br /> In person Mail Phone <br /> Requested By: Subject of Data Not Subject of Data <br /> equ t` <br /> Information Requested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> P <br /> Request is: <br /> Auproved Denied Approved in Part <br /> Remarks/Comments: <br /> '1&40 <br /> It/ <br /> Authorized Signature: � C / <br /> / <br /> Fees:- x $Total Due <br /> No. of Pages Rate per Page <br />