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ORONO ADMSNIS�RATNE �FF=C�S <br /> =3�TFORMATION DISCLDATAEPR CTIC�S gCT <br /> � MSNNESOTA Ga <br /> • gEQIIESTER NOTE: . <br /> A, gequest Frequency - Private Data on iadividuals. A��e= y°u <br /> have been supplied the data and informed of its meani.ng, the <br /> data need nat be discZosed to 1'ending or addit onaledatat-on <br /> �unless `a dispute or ac..ion is p <br /> you .has been col.Iected. <br /> B, you may be reauired to pay actual costs in �aking, <br /> certifying and%or compiling tae copies o= information <br /> requested. • <br /> J � ��' ���vr��V� � '�\J��11 <br /> Date af Request: !, <br /> � ' ����� � -� l�V�.L�,._.�j� �-1..,rz��,�'t�-eii�� <br /> �"�,C�.Y�Y-��Q �-x:-�Z� � <br /> Requester Name: � -�"�`-i`� <br /> . -� ��{ �� �-�- '� `-� `\� city: s� P���-► <br /> p�,�ddress- <br /> �-�� \� �, <br /> Z ip= � <br /> - - Business: � " <br /> C� 11-��-�1 S ��E� <br /> HQme Phone: -�. <br /> n 'V '','� c � <br /> • este3: �✓� .-��:: � .�.>��. �J � v• <br /> Description of Information Reuu , <br /> � <br /> '1 <br /> �1 ��,�, i �-\�S� � r� �. <br /> I�9��u �--'�� G� ,__� . ' <br /> � <br /> �\�� <br /> � <br /> �-�--„� �-=�.r � <br /> gequester'. s Signature: � <br /> BgyOW INgOR�`iATION TO BE I.LED IN BY DEPARTMgNT OI�"LY <br /> e artment: (�� z Handled By: o�� �. <br /> D p <br /> Mail Phone <br /> gequest Type: _�.In person . — — <br /> gequested By= <br /> Subjec:. of Data �_Not Su°Jec` o= Data <br /> Tnf ozmation Requ <br /> este3 is Classified: =�Ii� _Przvate <br /> Nan-?ublic =rotected Nan-Public <br /> Conf idential _ <br /> A�proved Denied Fnproved in_Part <br /> ge�uest i.s: _� — <br /> Re�arks/Camments: <br /> Anthori.ze3 Signature: <br /> _ $ <br /> Fees:• x Total Due ,. <br /> No. of Pages Rate per Page <br />