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ORONO ADMINIS�R.ATNE OFFSCES <br /> INFORMATION DISCLOSIIRE RE4IIEST <br /> � IiSNNESOTA Ga DATA PR�iCTICES ACT <br /> • gBQIIES�ER NO�E= <br /> A_ Request Frequency - Private Data on individuals. After you <br /> have been supp?:-ea the data and informed of its meaning, the <br /> data need not be disclosed to Yenaing or add tional edatat�on <br /> unless a dispute or acti.on is p <br /> you .has been col.lected. <br /> B , you may be required to pay actual costs in making. <br /> certifying and/or compiling the copies o= in=ormation <br /> requested. � <br /> Date of Reques-t: J� ���' � � <br /> ; . / { �-. <br /> �-��,�' �,,'�t � y � <br /> Requester Name= r- �r <br /> c �. �.���c-� r <br /> �_ � c' � City: C <br /> AC3d2@SS: �c � ^ �F�z </j� i <br /> �'�� <br /> Zip- l;_ �.-"j � �/ <br /> � �i�� �' i �� Business: <br /> Some Phone: �i �� � ' �� � <br /> � _ , �,� � <br /> �,_�_�� � �� / . y ,: <br /> Description of Information Reuuested: <br /> C � �` �7 /-�? ':, /'� ,�"�� �)'�/� ��l, . <br /> � �� _� � � <br /> , , <br /> ,� �— __ <br /> e: >'�`"��_ - .�-�z� �.� r� _' <br /> � gequester'. s Signatur =� �"��� � � <br /> � ,. ':� <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONI,Y <br /> � �Z Handled By: .•� <br /> D ep artment= <br /> Reqaest Type= /� In pe'-"son <br /> Mail Phone <br /> geques-�.ed By: <br /> Subjec;. o= Data �_Not S��eC` �= Datz <br /> Inf ormation Requ <br /> ested is Classified: �_�ublic Private <br /> Con=idential <br /> Non-?ublic =rotected Non-Public <br /> Approved Denied P_pproved in_Part <br /> gequest is: ,�_ — <br /> Remarks/Ca�ents: <br /> Autb.orized Signature: <br /> _ $ <br /> Fees:• x Total Due .. <br /> No. of Pages Rate per Page .. <br />