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1 <br /> ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNMENT 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: <br /> Requester Name: <br /> Address: City: <br /> Zip: <br /> Home Phone: Business: <br /> Description of Information Requested: <br /> Requester' s Signature: <br /> BELOW INFORMATION TO BE FILI,ED IN BY DEPARTM�?NT ONLY <br /> Department: ��j G Z 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: _�X Approved Denied Approved in Part <br /> Remarks/Comments: <br /> Authorized Signature: -� �-��,- <br /> � � �� <br /> ' <,� c _ $ � _ t_. <br /> Fees:� ��:, X � � _ <br /> No. of Pages Rate per Page Total Due <br />