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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQIIEST <br /> MINNESOTA GO�i�RN�NT DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data on <br /> you has been collected. <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:��-r�� �-� =� <br /> Requester Name: ���-�� � � �-�``"-``"'"`� <br /> Addre s s: :� '/C/ i��--�-C� �-rc-�_- City: ,���y,,��-,-��_� <br /> Zip: j � � �/� <br /> Home Phone: � � 3 -�f �/ Business: �� �j� �� 3 G J.� � <br /> Description of Information Requested: ��--� �y�^-�-��y <br /> � <br /> �„-� 7��� ..S-��..r�a� � �� '� 5 � ; 3 C�c:� 3_�s�, 3�fc�C <br /> Requester' s Signature: ,%�'���,��' '�-�����-`�'-��� <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMF?NT 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 />