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ORONO ADMINISTRATIVE OFFICES <br /> INFORIKATION DISCLOSIIRE REQDSST <br /> MINNESOTA GOVER1�II�iT DATA PRACTIGES ACT <br /> REQIISSTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied 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 action is pending or additional data on <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Request: ��/Zs/�// <br /> Reqnester Name: T�o»��-s , �.v�-� <br /> �ddress: /57�,� �'����r v✓�-�� �� . City: ST . �l�. � <br /> Zip: �� .3c� � <br /> Ho�e Phone: ��Z "��� 'G'��� Bnsiness: � <br /> Description of Information Requested: � �e ���� � �yZ� �f /�• � <br /> Reqnester's Signature: � u�-� c;c.�- � <br /> BffiAW INFORI�lATION Tb B8 FILLED BY DEPARTl98NT ONLY <br /> Department: Handled By: <br /> Request Type: In person Mail Phone <br /> Reqnested By: Subject of Data Not Subject of Data , <br /> Information Reqnested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Reqnest is: Approved Denied Approved in Part <br /> Re�arks/Cc�ments: <br /> Authoriaed Signatnre: <br /> Fees: x = $ <br /> No. of Pages Rate per Page Total Due <br />