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ORONO ADMINISTRATIVE OFFICBS <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNMSNT DATA PRACTICES ACT <br /> REQIIESTER 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 for six months thereafter <br /> unless a dispute or action is pending or additional data on <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 /> � ,! , / � �- ; , <br /> Date of Request: � � � � <br /> . <br /> � � � <br /> Requester Name: �� �f'��"/ ;�"1 ,�� � ��,'/l� i <br /> , � , � _,� �-� �, City: /(�� /�� <br /> Address: j- > i � �� ,,�� < < � <br /> Zip: -� , =, `% <br /> Home Phone. -j�� �.��-,<' Business: '; %� � yy`!;, <br /> " � / <br /> Description of Information Requested: -�i���� L��'i�� � ��� � '� (`� � <br /> , �','/���/�'L; <br /> � , <br /> � ; <br /> Requester' s Signature: l i '� � � <br /> BELOW INFORMATION TO BE FII,LED IN BY DEPARTM�?NT ONLY <br /> Department: Handled By: <br /> Request Type: In person Mail Phone <br /> Requested By: Subject of Data Not Subject of Data <br /> Information Requested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> Re�uest is: Approved Denied Approved in Par� <br /> Remarks/Camments: <br /> Authorized Signature: <br /> Fees: x = $ <br /> No, of Pages Rate per Page Total Due <br />