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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCI�OSIIRE KEQIIEST <br /> �+iINNESOTA Ga DATA PRACTICES ACT <br /> RE4DESTER 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 needdistute orsaction is pendina or add tional edatat-on <br /> unless a p . <br /> you has been collectec. �ctual costs in making, <br /> g, you may be required to pay <br /> certifying and/or compiling the copies o= iniormation <br /> requested. <br /> Date of Request: ��� �� � � <br /> � ,5 Gz- ia „� J� a �� � <br /> Requester Name: <br /> ,—� ) v� O �1 C� <br /> �ddress: ���' �` � S/� ��� � City: <br /> zip: �s`-�3 / <br /> Home Phone: L� � 3^ <br /> 2� 3 S� Business: <br /> Description of Information Requested: <br /> Requester' s Signature: <br /> � `�--/ _.� --- <br /> gELOW INFORMATION TO BE FII.I�ED IN BY DEPARTME?NT ONLY <br /> Handled By: <br /> Departsnent: <br /> In erson MaiZ Phone <br /> Request Type: P <br /> R ested B Subjec� or Data Not Subject of Data <br /> � y: <br /> Inf ormation Re�qu <br /> ested is Classified: ?ublic Private <br /> Confidential Non-�ublic =rotected Non-Public <br /> ge�uest is: <br /> Approved Denied Approved in Part <br /> Remarks/Co�ents: <br /> Authorized Signature: <br /> _ $ <br /> Fees: X Total Due <br /> No. of Pages Rate per Page .. <br />