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ORONO ADMINISTRATSVE OFFICES <br /> INFORMATION DISCI�OSIIRE REQIIEST <br /> I�SII�7NESOTA GO DATA PRACTICES ACT <br /> REQIIESTER NOTEs <br /> A, Request Frequency - Private Data on individua?s. After you <br /> have been supplied the data and informed of its meaning, the <br /> data needdnstube orsaction is pending or add tional edatat-on <br /> unless a p , <br /> you has been collected. <br /> B, You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies oi information <br /> requested. <br /> � '��— - <br /> Date of Request: � <br /> Requester Name: � <br /> City: � <br /> Address: �1�� <br /> Zip= �S �� — ��J,,l <br /> �� .-/T-/� C� �� lJ <br /> game Phone: '` Business= <br /> Description of Information Reqa <br /> ested: � ��//�— <br /> Requester' s Signature: <br /> �—. <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTI�?NT ONLY <br /> Handled By: <br /> Department: <br /> In erson Mai1 Phone <br /> Request Type: P <br /> g ested B Subjec� or Data Not Subject of Data <br /> equ Y= <br /> Inf ormation Requ <br /> ested is Classified: aublic Private <br /> Confidential Nor.-�ublic =rotected Non-Pubiic <br /> Reqnest is: <br /> Aporoved Denied Approved in Part <br /> Rpmarks/Camments- <br /> Authorized Signature: <br /> _ $ <br /> Fees: X Total Due <br /> No. of Pages Rate per Page .. <br />