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o�=cEs � <br /> ORONO ADMIN=STRP'TNE �Q�ST <br /> rI1FOg,MATION DI�SCTLOUA� PRACTICES ACT <br /> IK2NNESOTA GaVE�� • <br /> �Q�S� N��� ency - Private Data on 'individuaZs. �te� the <br /> A, Request Frequ <br /> have been supplied the data and ouf foresixfmonthsethereafter <br /> data need notu�e orsaction is pending or additional data -on <br /> unless a disp . <br /> you has been coZlected. a zctual costs in �aking, <br /> g, You may be rea_uired to P yt�e copies oi info mation <br /> certifyiag and/or coinpiling <br /> requested. � <br /> ' l9 <br /> Date of Request: " <br /> � Jd,l S�L�1 �'t� l,u , <br /> Requester Name: � r�E <br /> � city: �D r� ' <br /> Address: ��Z� � V l��,u <br /> Zip: �J53�� <br /> �3_�� susiness: �� �^� a�'� <br /> gome rhone: r �D b � ��C�.ht-p S ��'1 <br /> Description of Iaforma�OII g�u <br /> ested: 1f-< <`� � � <br /> Re�ester: s Signature= <br /> BgyQW =NgOgM�TION TO BE FII.LID <br /> IN BY DEPARTI�NT ONZ'�Y <br /> Ha.adle� BY= <br /> . Departmen:t= <br /> Mai? Phone <br /> In person — — <br /> gequest Type= Data <br /> gequested By: Subj <br /> ec� vf Data Not Subject o� <br /> J,�o�matian Requested is Classified= <br /> �ublic _P�ivate <br /> Nan-?ublic =rotected Non-Public <br /> Conf idential — <br /> Denied A�proved iY�. Part <br /> gequest is: Approved — -- - � <br /> R�,ar3zs/co��ts: <br /> . � � � <br /> AuthoZized Signature: <br /> = S <br /> X Total Due <br /> Fees:� e5 Rate per Page .. <br /> No. of Pag <br />