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ORONO ADMINISTRATIVE OFFICES <br /> INFORMP.TION DISCLOSDRE RE4IIEST <br /> MINNESOTA Ga DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A, Request Frequency - Private Data on individuals. Af ter the <br /> have been supplied the data and informed of its meaning, <br /> data need not be disclosed to yendinq or add tional edatat�on <br /> unless a dispute or action is p <br /> you has been coilected. <br /> g, You may be required to pay actual costs in making, <br /> certifying and/or cornpiling the copies or information <br /> requested. <br /> Date of Request: �� �� � �� � <br /> : r' U �' <br /> Requester Name: <br /> Address: 33 <br /> fxa �t�n-+���Gu. `�'.�.t '� 2 I ( city: �t��IL <br /> Zip: �� �"�•�`'1 <br /> gome Phone: ���-' �.���� Business : <br /> �°i "'1 - �� �� � :'. <br /> Description of Inf ormation Requested: ����'�-� ���� i <br /> ��V� � �� -�' <br /> ,,; <br /> � (��� `f� �( j � ( � � � ���_ �.�1�-�t��_ E.0 <br /> Requester' s Signature: <br /> BELOW INFORMATION TO B FI ED IN BY DEPARZ'MENT ONLY <br /> Handled By s <br /> Department: <br /> gequest Type= In persan <br /> Mai1 Phone <br /> ested B Subject or Data Not Subject of Data <br /> Re�qu Y= <br /> Information Re�uested is Classified: <br /> �ublic Private <br /> Confidential <br /> Non-?ublic -rotected Non-Public <br /> gequest is: Approved Denied Approved in Part <br /> Remarks/Camments: <br /> Authorized Signature: <br /> _ $ <br /> Fees: x er page Total Due <br /> No, of Pages Rate p .�.' <br />