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ORONO ADMI232STRATSYE ��=�S � <br /> 1�`TFORMATION D=SCLOSIIRE REQIIEST _ <br /> • � �42NNESOTA GO DATA PR�CTICES gCT , <br /> � gEQ�ES�EK NOTE= . <br /> �. pecrt:est Frequency - Private DatinfQr�d ofaitssaezning, th= <br /> hac'e been supplied the aata and ou yor six nont:ns thereafter � <br /> nata nead not be disclosed tO yending or additional data -on <br /> . .unless .`a dispute or ac�ion is �p . . � . <br /> you .has been collected. � <br /> g. you may be =eauir�ec to pay��actual costs in �akinq, <br /> certifying and/or co��iling the cooies or infora.ati�r <br /> requested. `//�� D • <br /> � / <br /> Date of Re�es�: � <br /> . - <br /> � <br /> Rec�aester Name: - ������'� <br /> . /,� � , City: v <br /> Address: �/ ` <br /> � Z ip: � <br /> Business= <br /> H�,e Phone� I <br /> Descr u <br /> ' on f o ation R _ ested:_ ' <br /> /� / / � . <br /> Rea'�eS�es'. s Signature: <br /> BFyOW INgOFtMATION TO BE FIIZID IN BY DEPART�'—''x� O�Y <br /> Hanaled bY= <br /> D ep ar''"�.ent: <br /> M�iZ Phone <br /> gequest Ty�e= In person . — — <br /> y: Subjec� of Data <br /> Not Sui��ec� vr" Data <br /> geqaes�ed B — <br /> �ui�lic _P='ivate <br /> Tnfozm,at=.on Reqaested is Classifi.ed: — <br /> Naz-?ublic -rotected Non-Public <br /> Coniidential ____ ;n pzt <br /> Denied � Aoproved __ <br /> ge�-¢est is: Aoproved — � <br /> Re.�arks�Cu�mests- <br /> . G�" _ �I � � � / <br /> p,II�orized Signatare: `' :� ;,;, . <br /> ,...,%` � = S <br /> Fees:• X Totzl Due „ <br /> No. of Pages Rate ner Fage <br /> . ; <br />