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ORONO ADMINISTRATIVE OFFS0-°S <br /> INFORMATION DISCLOSU-:LE P-EQUEST <br /> HrNNESOTA G40VEPIUCENT DATA PRACTICES ACT ' <br /> R QUESTER NOTE: <br /> ' Pester you <br /> A. Bequest Frequency - Private Data on individuals. aningr the <br /> have been supplied the data and ouf f resixf monthsethereafter <br /> data need not be disclosed to y <br /> . .unless <br /> a dispute or action is -pending or additional data -o^- <br /> you .has been collected. <br /> you may be required to pay actual costs in making; <br /> B. - • and/or compiling the copies or inforaation <br /> ger cif Ying <br /> requested. <br /> Date of Request: Co -� <br /> Regaester 'Sa=e: <br /> �z11 City: <br /> Address: <br /> Business: <br /> Home Phone: <br /> Ct <br /> Description of Information Requested: <br /> of <br /> ature: <br /> Recruestes'. s Sign -� <br /> BELOW INFORMATION TO BE FILL]ED IN BY DEPARZ'I�=NT O '�' <br /> Depar�•=ent: G G�lrw, <br /> Handled By: <br /> Bequest Type= —In person . <br /> Mzi; Phone <br /> Requested By: — <br /> Subject-- of Data Not Subject of Data <br /> Tnformat- Requested is Classified: <br /> Publi c _Private <br /> protected Non-Public <br /> Non-public <br /> _Confidential in Part <br /> u <br /> Reqest is: Approved <br /> Denied Approved <br /> Rem. Tks/Conv=ents: <br /> Authorized SignatBre: <br /> Fees:- x Rate per Page Total Due ,. <br /> arm _ of Pages . <br />