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ORONO ADMINISTR�iTIVE OFFICES <br /> INFORM�TION DISCI�OSIIRE REQIIEST <br /> MINNESOTA Ga DATA PRACTICES ACT <br /> REQIIESTER NOTEs . <br /> A, Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, <br /> the <br /> data need notu�e orsacti n is pend ng or aaa t onal edatat�on <br /> unless a disp . <br /> you has been collected. <br /> B. y o u m a y b e r e q u i red to pa y actual costs in making, <br /> certif ying and/or compiling the copies of in f o r m a t i o n <br /> requested. - <br /> Date of Request s � �� 6 <br /> Requester Name: ��'�' ��( <br /> Address: I (U v W��-��'''�� �0 City: �iP�d <br /> ZiP: SS �� � <br /> Home Phone: �U�� ��� �/ Busines s: <br /> Description of Iaformation Requ <br /> ested: C�nI S�R�c-��� `� V�i�'dCF <br /> {-h Sr�,2 F �RuPc� � ��1 H �� S .ww� <br /> � � 1( <br /> Re�uester: s Signature: <br /> BELOW INFORMATION TO BE FII�LED IN BY DEPARTM�NT ONLY <br /> Handled By: ' <br /> Depart�ent: d a Z - <br /> Request Type= <br /> _In person MaiZ Phone <br /> gequested By: <br /> Subject of Data _�_Not Subject of Data <br /> Information Requested is Classified: <br /> o< Public Private <br /> Confidential Non-�ublic _�==otected Non-Public <br /> Denied Approved in Part <br /> Reqnest is: � Approved _ <br /> Remarks/Comments- <br /> Authorized Signature: � <br /> _ $ <br /> Fees:� x Total Due <br /> No. of Pages Rate per Page -. <br />