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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE PRACTICESATA REQUEST <br /> ACT <br /> MINNESOTA GOVERNMENT <br /> REQIIESTEtt NOTE: <br /> A. Request Frequency - Private Data on individuals. After the <br /> ou <br /> have been not be disclosed to youhe data and ffored sixfits monthseaning,thereafter <br /> data need not or additional data -on <br /> unless a dispute or action is pending <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 /> Date of Request: /1 / / t-/ <br /> Requester Name: i. ' <br /> ' ler - are fl <br /> Address: Tic. 946)7,1 7,1 Yreer City: 1_4„02,1L-___ <br /> `___________25,_--5(4 /' - rG.� <br /> Zip: /7� <br /> Business: , <br /> Home Phone: ////// � —Z�iu <br /> Description of Information Requested: UVili- �C� - 1 <br /> Requester' s Signature: <br /> BELOW INFORMATION TO BE MILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Depai gent: <br /> Request Type: In person <br /> Mai? Phone. <br /> Requested By: Subject of Data Not Subject of Data <br /> equ <br /> Public Private <br /> Tnformation Requested is Classified: 4 <br /> Confidential <br /> Non-Public Protected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> Remarks/Comments: <br /> ti <br /> Authorized Signature:: �. I , ! ii .-__ <br /> Fees: x Total Due <br /> No. of Pages Rate per Page <br />