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ORONO ADMINISTRATIVE OFFICES . <br /> INE'Og�S�1TION DSSCLOSIIRE R�4�ST <br /> MINNESOTA Ga DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A. Request Frequency - Private Data on individual.s. After the <br /> have been suppl.ied the d etda �o a oufforesixfmontnsethereafter <br /> data need not be disclos yending or additional data -on <br /> unless a dispute or actioa is p <br /> you has been collected. a �,ctual costs in making, <br /> B, you �ay be required to P ytre copies o= information <br /> certif ying and/or compiling <br /> requested. � <br /> Date of Request: \� \ <br /> , , . <br /> Requester Namez (� <br /> City: ��� <br /> p,ddsess: <br /> Zip: <br /> Business s � R <br /> H�e Phone: ���__���C�� �,..e. \1 <br /> Descrip'�-on of Informat�oa g�uested: <br /> �" ' � l�.ti � ��-� <br /> Reqaester` s Signat�re: <br /> BgyaW IZ�7gOgMATION TO BE FII� IN BY DEPARTI�:NT O�'Y <br /> Handled BY= <br /> Department: <br /> Mai? _Phone. <br /> gequest TYPe: <br /> In person — <br /> gequested By: Subjec� o= Data <br /> Not Subject of Data <br /> ��, Zi� _Private <br /> Tnfoffiation Reqneste3 is Classified= <br /> Noa-Public =rotected Non-Public <br /> Conf idential — <br /> Denied Approved in Par� <br /> Re�ueSt 1S� Aporoved --i - <br /> Remar3ts/Camments: <br /> Authorized Signat�e: <br /> _ $ <br /> X Total Due <br /> Fe�s:� Rate per Page " <br /> No, of Pages <br />