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ORONO ADM2�3IS�RATN� �FF=�S <br /> INFORMATION DISCLOnA�EPR CTICES B.CT <br /> � 2�4SNNESOTA GO <br /> • gEQIIES2'F�Z NO�E- <br /> A. Request Frequency - Private D a infor�rcedi of itsSmeaninJ. the <br /> have been supplied the aata an ou for six r�on'r..iis thereafter <br /> data aeed not be disclosed t� 1'endinq vr adaitional data -on <br /> unless 'a dispute or action is p <br /> you .has been col.I.ected. <br /> B, you may be reauired to pay actual costs in making, <br /> certifying and/or compiling the co�ies o= infornation <br /> requested. � <br /> Date of Request: <br /> . � �-_-� �, 1 <br /> �1 -f--�,. �,_ , ,,",,� ,. <br /> Requester Name: - <br /> . City: <br /> p�ddress: <br /> zip" �. � � ��f �� '' '"�L ��c.� :>�'� <br /> • �.� � `,� .a.� �.��- ,f <br /> Home Phone-�� � ?1 3 � y' � �(D� <br /> Busi.nes s: <br /> Description of =nf�rma�on Reuueste3: <br /> c� ��. ��� <br /> ..__... t _, '`� �,� '�<...-..e'. '7 <br /> ��y `-!''. ; '� <br /> geques�er'. s Signature: ,. ._r.�,�--.. .-_ .._ <br /> .,. ...� <br /> Bgy0y7 INFOFLMATION TO BE FII�LED IN BY DEPAR�MENT �NI'Y <br /> Handled Bys <br /> D ep art�ent= <br /> Mai1 Phone <br /> gequest Type= _In Pe'-"son . — — <br /> Subjec� o= Data Not Subject of Data <br /> gequested $y= ` <br /> ested is Classified: �unZi� Private <br /> �fo�ation Requ .--- <br /> Conf idential <br /> Noa-?ublic =rotected Non-Public <br /> Denied P_nproved in_Pat <br /> Request is: Aporoved — <br /> Remarks/Ca�ents: <br /> Anth <br /> orize3 Signature: / ` <br /> = S <br /> Fees:• X Total Due ._ <br /> No. of Pages Rate per Page <br />