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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GOVERNMNT DATA PRACTICES ACT <br /> REQUESTER NOTE. - Private Data on individuals. After you <br /> A. Request Frequency the <br /> have been supplied the data and informed <br /> ofx <br /> seanineafthe <br /> r <br /> data need not be disclosed to you <br /> unless a dispute or action is pending or additional data -on <br /> you has been collected. actual costs in making, <br /> B. You may be required to pay the copies of informationcertifying and/Or compiling <br /> requested. <br /> Date of Request: //--4 - 5 7 <br /> Requester Name: <br /> /� City: 222.....!.-. 71-_—. .s . <br /> O 1---,— i4-, 1 <br /> p„ddress <br /> Zip: Ls23 / <br /> Home Phone: ±'l 2 0 f r 7 5 <br /> Business: 3G f"'- "-________la..---_ <br /> 7�2 <br /> Description of Information Requested: <br /> . e - ( _ 6,. c. <br /> z <br /> iirsoiv <br /> Requester' s Signature: <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department= <br /> $equest Type: _In person <br /> Mai? Phone. <br /> Requested By: Subject of Data Not Subject of Data <br /> Information Requested is Classified: <br /> Public - <br /> Private <br /> Confidential <br /> Nor.-Public Protected Non-Public <br /> Request is: Approved <br /> Denied Approved in Part <br /> Remarks/Comments: <br /> Authorized Signature: <br /> x Total Due <br /> Fees: es Rate per Page <br /> No. of Pages <br />