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OROIIO ADHSNSSTRAT=VE ����S ' <br /> INFORMATION DISCLOSUKE Kti'4�ST <br /> • � tfSi�NESOTA GO DATA PR�CTICES ACT ' <br /> ° gEQUES�F�Z NOZ'E= • <br /> A. gequest Frequenc� - Private Data on indiciduals. ��te= �ho <br /> h�c�e been supplied the aata and ouf fo eSiXfnon'r�_'r�se herezfter � <br /> a�ta n.e�d not be disclosed to y <br /> .unless ��a dispute or ac�ion is �pendinQ or additional dat� 'on <br /> you .has been col.Iected. � <br /> you m,ay be reauired to pay ��actual costs in �aking. <br /> B. the co�ies o� in=oraatior_ <br /> certifying and/or co�piling <br /> reauested. `�/�� O • <br /> Date of Request: r <br /> ` �e= � <br /> Rea-uester N " �;����,/� <br /> . �,� � City: � <br /> A.d�re s s: ��/ ` <br /> ZiD- <br /> Business: <br /> H�e Phone= I j_ <br /> Descr tr � on f o _ <br /> ation R <br /> ested: � � ,c�C.� <br /> � � . <br /> J <br /> gecrues�es'. s Signature: <br /> gELOW 1NFORMATION TO BE FII�F� IN BY DEPAR��'�N� ��'�-' <br /> sa.xiale3 sy: <br /> D ep ar`"��'�= <br /> Mail Phone <br /> gequest Type= in person . — — <br /> gequested By= — <br /> Subjec� o= Data Not Su�je�� o= Dztz <br /> _�Z,� Priv�te <br /> Tnfo�mation Requested is Classifie�d: — --- <br /> Naa-?ubli.c =rotected Non-Public <br /> Con=idential � <br /> Denied Annroved in_Part <br /> gecruest is: Aooroved — . <br /> Fze�arks�Car�ents- <br /> � ' � /. <br /> , <br /> An�horized Signa <br /> tare: Gi" � k� � � � � - <br /> •% ' = S <br /> Pees:• X Tota� Due „ <br /> No. of Pages R�te ver Fage <br /> , <br />