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ORONO ADMrNISTRATIYE �FFICES � <br /> =3�TE'ORMATION DISCLOSIIRE RE4IIEST <br /> . I�iIN�TEgaTp, GO DATA PR�CTICES ACT <br /> ' gEQIIESTER NOTE: . - <br /> p,. Request Frequency - Private Data on individuals. Afte� Y°u <br /> have been suppl.ied the data and informed of its meaning, the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or ac�ion is pending or additional data -on <br /> you .has been collected. <br /> B, you may be requirec to pay actual costs in making, <br /> certifying and/or com�iling the copies of information <br /> requested. • <br /> Date of Request: �O` a 3"g9 <br /> Requester Name: ���1 -rt � �`'��ln.,,�GiT��V <br /> /�C� !:A?� 5� City: ���)N�/,���(1� <br /> Address: . , <br /> ZiP: SS 3 � 7 <br /> Some Phone: <br /> 3(p �- (��p� Business: S/�1�� <br /> Description af Iafor�atioa Requeste3: STI2'PP?` F�L�' <br /> �S � <br /> � Requester'.s Signature: <br /> BELOW 2NFORMATION TO BE FII.I�ED N BY DEPARTMENT ONLY <br /> ��.,L Han.alea. By: ��. <br /> Department: <br /> In erson Mail Phone. <br /> Request Type= _ � P � — — <br /> g ested B _Subjec� of Data _� Not Subject of Data <br /> � y' <br /> Tn�Formation Reqa <br /> ested is Classified: �_�ublic Private <br /> Confidential Non-?ublic =rotected Non-Public <br /> Denied Approved in Part <br /> Request is: � Approved ,_ -- <br /> Remarks/Co�ents: <br /> Authorized Signature: � <br /> _ $ <br /> Fess:• x Total Due .. <br /> No. of Pages Rate per Page <br />