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ORONO ADMINISTRATIVE OFFICES <br /> INFOFtMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNM$NT DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. Aft�- u <br /> ha�v�-��e�-sug�lied the data and informed of��--�t��iin the <br /> data need not be c�i���i-e�d_to you_���-�x months t eafter ; �' •� _ � <br /> unless a dispute ��r�-o�—i� pen3i�r�—e�--a�d_itio�x data on \ <br /> you �a-�-�een oc llected. � �_'------_-_-. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of �Request s �0������ <br /> � � �,/ ,, -- <br /> Requester Name: =C y�"I � ;' i ' l� <br /> �_ <br /> Address- �0 /.1i(}'� ,� i�a..: , City: Jf f";1r:,(' <br /> Zip: V� /�/ <br /> Home Phone: �� ���� - '';��� Business: <br /> Description of Information Requested: �'��:�'�,�� �-���r^ <br /> Requester' s Signature: <br /> BELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT 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 />