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ORONO ADMINISTRATNE OFFI�S � <br /> INFORMATION DISCLOSIIRE RE4IIEST <br /> . MSN�TESpTA G� DATA PR�CTICES ACT <br /> • ggQt7ES�ER NOTE: � <br /> A. gequest Frequency - Private Datinfor�d ofaitssmeaning. the <br /> have been supplied the aata and ou for six monL:ns thereafter <br /> data need not be disclosed to y <br /> unless a dispute or ac�ion is pending vr additional data -on <br /> you .has been col.Iected. <br /> g. you may be reauired to pay actual costs in makinq, <br /> certifying and%or compiling the copie5 oi inforaatior_ <br /> requested. - <br /> Date of Request: <br /> Fi � 1 1 �-� <br /> � � � • � �, j (�e.n i.�c �,..,-,—.}- L �� <br /> Requester Name: w � � �"S . <br /> � ,. City: �f �''� � <br /> �aa=ess: <br /> D� R� � � <br /> � � �, � � <br /> Zip: <br /> H�e Phone: � � � <br /> - r S � � Busines s: L-'��` �``. `"�J <br /> Description of Information Reuuested: <br /> �� __.._----___.._ <br /> Reuuester'. s Signature: <br /> Bg�,OW INFORMATION TO BE FII�LED IN BY DEPAR�NT OZTLY <br /> Handled By= � � • — <br /> Department= Q � Z <br /> Mail. Phone <br /> gequest Type- �D _In person . — -- <br /> gequested $y= — <br /> Subjec� o= Data �_Not Sui�ject of Data <br /> Tnformation Requ <br /> ested is Classified: _���Ii� _Priv�te <br /> Conf idential <br /> Non-�ublic =rotected Non-Public <br /> A��roved Denied Anproved in_Par't <br /> gec�aest is: �_ — <br /> Re�arks/Co�me�ts: <br /> Anthorized Signatare: <br /> _ $ <br /> Fees:- X Total Due _. <br /> No. of Pages Rate per Page .. <br />