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ORONO ADMINISTRATIVE OFFICSS <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQIIESTER 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 /> cf <br /> Date of Request: � � / <br /> � , <br /> Requester Name: <br /> Address: S��D =5 � � ��,f� City: "` 2i� <br /> ZlP: ;�/��fj�3i��� <br /> Home Phone: ��i �l- ��G�� Busines s: ���j�% �� � � <br /> Description of InfoYmation Requested: �� ' , <br /> � <br /> � � , <br /> i �- %.� <br /> ...� f C/ 1��� <br /> �' % ��� � < � <br /> Requester's ignature: <br /> BELOW INFORMATION TO BB FILLED IN BY DEPARTIKENT ONLY <br /> Department: (; 4 G� Handled By: -;'�,.,, ,_,��, <br /> Request Type: � In person Mail Phone <br /> Requested By: Subject of Data ��Not Subject of Data <br /> Information Requested is Classified: �`�' Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Request is: ���' Approved Denied Approved in Part <br /> Remarks/Comments: <br /> r , <br /> Authorized Signature: �� , � ;��u�. <br /> Fees: x = $ <br /> No. of Pages Rate per Page Total Due � <br />