Fillable CityofDuluth FireDepartment REQUESTFORINFORMATIO N (City of Duluth)

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CityofDuluth FireDepartment REQUESTFORINFORMATIO N (City of Duluth)

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CityofDuluth
FireDepartment
602 West 2
nd
Street • Duluth, Minnesota • 55802
(218)730-4394 • Fax (218)730-4381 • http://www.duluthmn.gov/fire/
An Equal Opportunity Employer

REQUESTFORINFORMATIO N
PUBLICUSE:OFFICEUSE:
Dateofrequest:_________________Dataclassified:□ Public □ Other
Requestor’sname:___________________________ Requestapproved/denied(circleone)
Requestor’saddress:____________ _________________ Reason: ___________________________________________
_______________________________________________ __________________________________________________
_______________________________________________ __________________________________________________
Requestor’sphone:_______________________________ Dateinformationprovided:_____________________
Descriptionofinformationrequested:________________ Chargesincurredinprovidinginformation:□Yes□No
Iagreetopaycharg
esupto$______beforebeingcontacted Copycharges:______________
bytheoffice.Research:__________________
Iprefertoinspecttherecordsinpersonbeforeanycopies Totalcharge:_______________
aremade:□Yes □No
_______________________________________________ _________________________________________________
SignaturePersonassignedtofillrequest
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CityofDuluth FireDepartment REQUESTFORINFORMATIO N (City of Duluth)

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Completed 3 August 2020

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