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ORONO ADMINISTRATIVE OFFICES <br /> 1NpORMATION DISCLOSURE REQUEST _ <br /> M2 SNESOTA GV RI MENT DATA PRACTICES ACT <br /> REQUESTER 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 <br /> or additional nal hs thereafter <br /> at-on <br /> .unless a dispute or action is p <br /> you .has' been collected. ts in making, <br /> B. You may be reauired to pay actual cos <br /> certifying and/or compiling the copies of information <br /> requested. �,/�7 <br /> /IUvDate of Request: _ <br /> Requester Name: / <br /> City: <br /> Address: <br /> Zip: .S <br /> Home Phone: <br /> Business: z- Z 2 Z O <br /> Description of Information Requested:. V�-! <br /> Requester' s Signature: c� <br /> BELOW INFORMATION TO BE F <br /> IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Request Type: In person . <br /> Mail Phone <br /> Requested By: <br /> Subjec� of Data Not Subject of Data <br /> Information Requested is Classified: ublic Private <br /> Confidential <br /> Non-Public <br /> -rotected Non-Public <br /> Approved Denied _ Approved in <br /> Request is: _ part . <br /> Remarks/Comments: <br /> Authorized <br /> Signature: <br /> gna <br /> Fees:• x Total Due ._ <br /> No. of Pages Rate per Page <br />