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I nepAune 4IX7 57 <br />CITYof ORONO <br />h.ni Office nos P:•Crrewl Hey. Minu,u«rw ORcu <br />On the North Shore of Lake Minnetonka <br />AUTHORIZATION TO RELEASE INFORMATION <br />As an applicant for a position with the City of Orono, I hereby <br />expressly authorize release of any and all information which you may <br />have concerning me, including information of a confidential or privi- <br />leged nature, which relates to my qualifications for this position. <br />I hereby release the City with which I am seeking employment, <br />and any organization, company or person furnishing information to <br />the City as expressly authorized above, from any liability which <br />may result from furnishing the information requested. <br />Date. Applicant'r <br />Signature: <br />�Tue� Imo, 19 �, --r <br />Applicant's Full v <br />Printed Name: L9URI h ) N FB <br />Applicant's n_ r <br />Address: ,Yi.lQ hYARY 46A1� <br />(Number) (Street) <br />�) /IW 55�.t.✓ <br />(City) (State) (Zip. <br />Applicant's <br />Social Security k: <br />