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ORONO ADMIN=STR�TIVE 0�=�S • <br /> 2NF'ORMATION DISCLOSURE RESZ�ST . <br /> • - 1�1SI�T�TESOTA GO DATA PR�CTICES gCT , <br /> • ggQL7ESTF�t NOTE= • <br /> " Af ter you <br /> A, gequest Frequenc� - Private� Data on individuals. th� <br /> hzc•e been supplied the data and uf faresixf aontnsehreafter • <br /> data ne�d not be disclosed t� yeadinc or additional data -on <br /> . • . .unless :a dispute or ac�ion is •p . � . • <br /> � you .has� beea. collected. . � <br /> you may be reauired to pay��zctual cos�s in makina; <br /> B- the copies or inioraatior_ <br /> certifying and/ar co�piling <br /> =equested. `���� O ' <br /> Date of Reqaest: _ r <br /> . • <br /> � <br /> gequester Name= <br /> �j� , City: ���/?� <br /> p�d,dress: v <br /> Z3.D' <br /> • $��@SS: <br /> H�e Phone: <br /> Descr <br /> -an f o , atioa R _ este3:. <br /> J . <br /> � Recrues�er`.s Signature: <br /> Bg,LOW INFORMATION TO BE FII�I,ED IN BY DEPAR�'T ONZ'Y <br /> Handled sy: <br /> D ep ar`'�ent: <br /> Mail. �hone <br /> geqnest TyPe= In person . — -- <br /> Not Subjec� of Data <br /> geques�ed Ey- Subjec:. of Data __ <br /> . ?unlic Private <br /> �o�atr.on Requested is Classified: <br /> =rotected Noa-�ubZzC . <br /> Confidential Noa-�ublic , ._._. . <br /> Denied � Annroved in_Pat <br /> gecuest is: Aporoved — ---- • <br /> Re�arks/C��ts: � <br /> j� K_. ,..r.�•�'K- °� <br /> 'zed SigIIature: G�' ,-`,;,'` ' <br /> Antb.on «�,• ;, <br /> = S <br /> X Total Due <br /> Pees:• NQ. a f ��geS Rate per Page <br /> f <br />