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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MlNNESOTA GOVEpMdENTDATA PRACTICES ACT <br /> REQUESTER NOTE- <br /> A. Request Frequency - Private Data on individuals. �=te= the <br /> :ace been supplied the data and informed <br /> f fo esixf months thereafter <br /> hereafter <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. a actual costs in making; <br /> B . you may be required to pay _ <br /> certifying and/or compiling the copies or in=oraatior_ <br /> requested. <br /> Date of Request: <br /> Requester Name: <br /> City: <br /> Address: C� <br /> Zip: <br /> Business: <br /> game Phone: <br /> Descr Dt-ion f Tlif o=at-ton R <br /> ested:. <br /> gequester'. s Signature: <br /> BELOW INFORMATION TO BE FILLED IN By DEPARTIx_7NT C'Zy <br /> Handled By: <br /> D ep aytment: <br /> Mail —Phone <br /> Bequest Type= _In Person • — <br /> Not Subject- of Data <br /> R <br /> equested By: Subject of Data <br /> — <br /> --public <br /> _Private <br /> I_nfojcat_ on Requested is Classified: — <br /> Non-Public <br /> protected Nom-Public <br /> _Confidential — <br /> eDenied Aoprovel int <br /> _Par <br /> Request is: Aooroved — 1 <br /> Remarks/Cents: <br /> An pori=ed Signature: <br /> Fees: x Tota? Due ., <br /> No. of Pages Rato per Page <br />