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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GoVmUqKEaTT DATA PRACTICES ACT . <br /> ,EQUESTP� NOTE: <br /> A. <br /> Request Frequency - private- Data iidualsPester tohe <br /> on indv . <br /> have been supplied the data and ouf f resixfmonrthsethereafter <br /> data need not be disclosed to You <br /> or additional data -on <br /> unless .'a dispute or action is p <br /> you .has been collected. <br /> be reauired to pay actual costs in making, <br /> You may the copies or information <br /> B, <br /> certifying and/or compiling <br /> requested. <br /> Date of Request: <br /> Regaester Name: <br /> City: <br /> Address: U <br /> Home Phone: q(6 <br /> Business: <br /> Description of Information Requested: <br /> K--A <br /> Reques ter* s Signature:�- <br /> . <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTM—ENT ONLY <br /> Handled By: <br /> Department: <br /> Request Type: —In person . <br /> Mai; phone <br /> Subject of Data Not Subject of Data <br /> Requested BY: — <br /> T_form.at=on Requested is Classified: Public _Private <br /> Non-public _=rotected Non-public <br /> _Confidential proved in Part <br /> Request is: Approved <br /> Denied P_p <br /> Re=arks/Comments: <br /> Authorized Signature: <br /> x per Page Total Due <br /> Fees:• ��_ of Pages Rate p e .. <br />