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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCILOSURE REQUEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQUESTER NOTE: ou <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, <br /> datalneedanodispute <br /> peorsclosed to you for six months action is pending or additional thereafter <br /> at-on <br /> unless a <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: li 161q1 <br /> Requester Name: lias 6t41 iq 0 Lc, Lr of <br /> 7 n �_tv City: ,- �� u <br /> Address: <br /> Zip: ) ) �' S 1, p / <br /> Home Phone: 7 �l1 <br /> 41 3 i Business: Z ri e r Tecc_ i 't- i <br /> /� <br /> Description of Information Requested: `t 7‘ C lAri '.t.1 i trt.(Jk Pd ic! L <br /> Requester's Signature: j4/1-4(,*- /CI-6-U) C'.% d <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Request Type: <br /> In person Mail Phone <br /> Requested By: Subject of Data Not Subject of Data <br /> Information Requested is Classified: <br /> Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> Remarks/Camments: <br /> Authorized Signature: <br /> Fees: x Total Due <br /> No. of Pages Rate per Page :. <br />