Laserfiche WebLink
OROIdO ADMINISTRAT=V� OFFS�S � <br /> r�p�2,M�TION DISCLOSURE R�Q�ST <br /> MINNESOT� Ga DAT� PRACTICES ACT <br /> REQUESTER NOTE: the <br /> A, Request Frecruency - Private Data on individuals. After you <br /> have be�n supplied the data and ouf fo eSiXfmonti�sethereafter <br /> data need not be disclosed to Yending or additional data -on <br /> unless a dispute or action is p <br /> you has been col.Iected. <br /> B . You may be required to p�Y <br /> actual costs in making► <br /> certifying and/or compiling <br /> tre copies oz in�ormat=-on <br /> requested. � <br /> Date of Re�uest: <br /> 3 / � / ct �, <br /> �_�, . � •�� <br /> � / �v� O � <br /> r- �• L> <br /> Reqnester Name: � <br /> ,� �i City: �e��n` y l� �o �ti <br /> Addr e s s: � f 7 �a �^ . 1-�}i� � <<�. <br /> Zip: ��5 11 � <br /> � , _ �, � �� -7 Business= <br /> gome Phone: � - <br /> Description of Informat�°n Requested: � .� <br /> � �{ ,.,_��' � ":/��2 ��-�'�� �. <br /> �-- � �, L�,� l,�_0 i� �- <br /> �,� �- ��, j-v��a x�Q o e � �. <br /> i.� C . G= ( <br /> pe / �{ .,�' L.�I/� J � <br /> �� �' �� /y w,Gi �"�� rj si L� (/��i^/�.l 'l �.� <br /> �.� /;� c � �t� � (�l-'� ' �, <br /> Reruester' s Signature: <br /> Bg,�,OW INgOR''iATSON TO BE FII,.LF.D <br /> IN BY DEPARZ�NT ON�Y <br /> � � � ''� � <br /> , <br /> ,��� .r 2 c�-�-�- � -'`- �-- <br /> Handled By: � �'�k �`-S' <br /> Departme.nt: '.a. <br /> / Mai? P. ne <br /> Request Type: V I=� Person <br /> Subjec� o= Data �Not Subjec� o= Data <br /> Requested By: — ` <br /> Info=mation Requeste3 is Classified: <br /> �=u�I.ic _Private <br /> Nan-?ub1±.c =rotec}ed Nan-PuDlic <br /> Conficeztial — <br /> Denied Aporoved in Part <br /> $equest is: � ADProved — <br /> Re�ar3�s/Comments: <br /> Authorize3 Signature: <br /> ,� ��,�G�, ' <br /> , = S <br /> X Tota1 Due <br /> Fe�s: es Rate per Page �- <br /> No. of Pag <br />