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ORONO ADMINISTRATIVE OFFICBS <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQDESTER 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: `�-�^ '� � ( �� l - <br /> � /� <br /> Requester Name: / t� i�-� � C ( `�l�T�-� t' <br /> Address: ����( ��� /r ��C V�� City: � 1�=� ��� <br /> zip: ��?� `I / • <br /> C� t Business: ��.�/�t�� e-t, <br /> Home Phone: �'( �� ' �' �'�' <br /> Description of Information Requested: d �' ��'�t i`l�s <br /> � � � ! � � ��- <br /> Reqnester' s Signature: ��°�`` ' ` _ <br /> BELOW INFORMATION TO BE FILLED IN BY DEP TMENT 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 /> Request is: Approved Denied Approved in Part <br /> Remarks/Camments: <br /> Authorized Signature: <br /> Fees: x = $ <br /> No, of Pages Rate per Page Total Due <br />