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ORONO ADMINIS2'RP,TSVE OFFI�S <br /> INFORMATION DISCLOSIIRE RE4IIEST <br /> 2r4INNESOTA GO DATA PR�CTICES ACT <br /> ' gEQUESTER NOTE: <br /> �. Request Frequency - Private Data on individua?s. After you <br /> have been supplied the data and informed of its meaning, <br /> the <br /> data needdistute orsaction is pendi q or add ti n 1 edatat-on <br /> unless a p <br /> you has been col.Iected. <br /> g. You may be requirec to pay actual costs in making, <br /> certifying and/or comailing the copies oi information <br /> requested. � • ' <br /> � <br /> J_ � L; � � ,�C �,:�%L��z�,�2G��'�/ :�ti1� <br /> �: ��.. <br /> Date of Request: <br /> � �-�NL� � ���rr�.,i��� F� <br /> Requester Name: ' , <br /> Address: <br /> /��`jS � �i '��'N� ���-��� city: .�'��/t�' �J <br /> � <br /> Zip: J����: <br /> ��C�� � ���G,� � Business : '�`" ��-��-�7��` �� <br /> Hame Phones , � _ <br /> L C G� -+� "-/�'���-��'�� � <br /> Description of Information Re�uested: � I <br /> � <br /> ^ <br /> ., �',���-���,�' ��C� , 7� �,`� �..� �`-�� ��CG��� �n ��`.ld�c� / <br /> � <br /> � <br /> w��—� �:�-�'c' - �c�—�C��z��f , <br /> � � �'����� :�� ���������'�t <br /> Requester' s Signature: <br /> gELOW INFORMATION TO BE FII.LED IN BY DEPARTMENT ONLY <br /> t. �� i �� � �;��-�`,L, � � �,s� Handled By: <br /> Departmen 'i <br /> �� In erson Mail. Phone <br /> Request Type= P <br /> R ested B Subjec� of Data �� Not Subject of Data <br /> es�'u Y' ` <br /> Information Re�u <br /> ested is Classified: �/ �ublic Private <br /> Confidential Non-�ublic =rotected Non-Public <br /> gequest is: �_Approved Denied Approved in Part <br /> Remarks/C�ents: <br /> �� . t�C�,� . <br /> Authorized Signature: -" `��'� <br /> _ $ <br /> Fees:� X Total Due <br /> No, of Pages Rate per Page •- <br />