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ORONO ADMSNISTRATNE ��=�S <br /> INFORMATION DISdDAAEPR CTICES ACT <br /> � ISSNNESOTA Ga <br /> ' gEQffES�F•R NOTEt . <br /> A, geauest Frequency - Private Datinfor�d of itssmeaning, the <br /> have been supplied the aata and ou for six monu�s thereafter <br /> data rieed not be disclosed to y <br /> �unless `a dispute or action is pendina or adaitional data -on <br /> you .has been collected. <br /> g, you may be reauirec to pay actual costs in making. <br /> certifying aad%or comailing the copies oL information <br /> requested. • <br /> v/ � <br /> Date of Request: ` <br /> � - ' �� � <br /> Requester Name: , <br /> > � / � City: � <br /> Address: �4�J� ( ���.c� C� � <br /> .� 53�� 1 � <br /> Zip: - . <br /> �/f - Business: � JU" a �� � G <br /> gome Phones � <br /> Descript-ion of Information Reuuested: r / <br /> � � ^ 9 -� <br /> � , • <br /> Reuuester`. s Signature: <br /> BgyOW �7gOR�`�SATION TO BE FII�I,ED IN BY DEPAR�� O�Y <br /> Handled BY= <br /> Department= <br /> Mail Phone <br /> gequest Type: In persan . — — <br /> Subjec�- of Data Not Subject of Data <br /> ge�uested Sy= — ` <br /> Tnfoimation Requ <br /> ested is Classified: ?u�Iic Private <br /> Con=idential Noa-?ublic <br /> =rotected Nan-Public <br /> Approved Denied ABproved in_Part <br /> gequest is: -- <br /> Remarks/Camments: <br /> Antb.orized Signa <br /> tBre: � <br /> _ � <br /> Fees:- X Total Due .. <br /> No. of Pages Rate per Page <br />