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ORONO ADMINIS�RATSYE ��=�S � <br /> INFORMATION DISCLOnS��P��I�S gCT <br /> � � �fINrTESOTA Ga , <br /> • gEQUES�ER NOTE= '� ' ?ndividuals. After you <br /> A, gecruest Frequency - Private Data o� <br /> the <br /> have been supplied the data and oufQQ es�xf�on�:nse hereafter � <br /> data ne�d nvt be disclosed to y <br /> .unless .�a dispute or ac�ion is �pending or additional data -on <br /> you .has been collected. _ <br /> You may be reauirec to pay��actual �cos�s in �akinq, <br /> S. zhe copies o� in=oraztiOP <br /> ce=tifying and%or �o�Piling <br /> requested. • <br /> est: - ZZ -- O/ <br /> Date af Requ , <br /> . - .�.�....�z ��1 r' ; � <br /> Name= ' <br /> Req�ester , � . , 2 �>�� / <br /> �I � City: <br /> p�r3dres s: �l��''C%� C �ti` <br /> � tiip: `-' S ,3i ( . . <br /> �� 3_�� S._� - `J ��5� Business: <br /> H�e Phone: �, , �, <br /> Descript-ion of =�O�a��n R�ested_, <br /> ,� � �-- ,� � s <br /> � � � <br /> ��L��� . � <br /> .� ature: '"�_�-..�.c,-t,_ <br /> :{� �_- <br /> Reaues..er'. s Sign <br /> BFyOW 127gORMATION TO BE FII�LE� I� BY DEPART2�+'--''NT O�TI'Y <br /> Eandled. sy: �� . <br /> D ep art�-aent= ��"� <br /> M�iZ Phone <br /> ge�uest Type= � In Pe=san . — — <br /> R�eSLe� By= _Subjec� oi Data <br /> �_Not Sunject or Data <br /> ��u:nlic Private <br /> =�o�mation R�q�ested is Classified= — <br /> =rotected Non-Public <br /> Na�-?ublic . <br /> Considential — . � �n Par� <br /> Denied � Annroved <br /> geuuest is: �,APoroved — --'— <br /> Re�sarks�Ca�.ests: <br /> Anthon-zed Sign.at�re: � <br /> _ $ <br /> Fees:• X Tota1 Due ,_ <br /> No. of Pages Rate per Page <br />