Last updated: June 19, 2018
CITY OF DULUTH
REQUEST FOR INFORMATION FORM
Minnesota Government Data Practices Act
GOVERNMENT DATA PRACTICES ACT CLASSIFICATION WARNING: The data you supply on this form will be used
to process your data request. The information you provide on this form is subject to the Minnesota Government
Data Practices Act and is classified as public data. You are not legally required to provide this data, but we may
not be able to process your request without it.
NAME*: _________________________________________________________________________
*You are not required to identify yourself or explain the reason for your data request. However, if you want us to mail/email
you copies of data or schedule an appointment to inspect data in-person, we will need some type of contact information. W
e
also need contact information if we do not understand your request. We will not work on your request until we can clarify it
w
ith you.
PHONE NUMBER: ____________________________________________________________
EMAIL ADDRESS: ____________________________________________________________
MAILING ADDRESS: ____________________________________________________________
____________________________________________________________
REQUEST DATE: ____________________________________________________________
D
escribe the data you are requesting as specifically as possible:
I
am requesting access to data in the following way: (mark one):
Inspection – no charge
Copies –25 cents per page for 100 or fewer paper copies of letter or legal sized paper copies (2-sided is 50
cents a copy). For copies of other data (more than 100 paper copies, photographs, data on a CD or DVD,
data stored electronically, etc.) the City charges the actual cost (not to exceed $25.00 per hour for employee
time) after the first one hour of employee time per data request. The first hour of employee time per data
request is free of charge.
Both inspection and copies - see charges above. You have the right to look at data, free of charge, before
deciding to request copies.
S
IGNATURE: _______________________________________________________________________
P
lease submit this form via email to the City Clerk’s Office, or by mail, or hand delivery to the City Clerk’s Office, Room
330, City Hall, 411 West First Street, Duluth, MN 55802
.
□ Approved
□ Approved in Part
□ Denied
Remarks or Basis for Denial Including Statute:
□ None □ ____ Pages x .25 cents = ________ □ Actual Costs: _____________________
Itemization of Actual Costs:
click to sign
signature
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