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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSIIRE RE4IIEST <br /> MINNESOTA GO DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A, Request Frequency - Private Data on individuals. After the <br /> have been supplied the data and infor�ed of its meaning, <br /> data need not be disclosed to yending or add tional edatat�on <br /> unless a dispute or action is p <br /> you has been collected. <br /> H, 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: I�r 1 �� j� <br /> Requester Name: �, ! ( '' S�"`'� <br /> Address: <br /> �� ��...0 <...., s r. city: 7�a.. I�. /1 , <br /> zip- s S3� ( <br /> Home Phone: �i ?� ,n `r S <br /> Business= � ��'`� 31� <br /> Description of Information Requested: <br /> �`���,;f ��� ��f - <br /> Reqaester' s Signature: <br /> BELOW INFORMATION TO BE FII.LED IN BY DEPART�NT O�TI'Y <br /> Handled By: <br /> Department: <br /> In erson MaiZ Phone <br /> Reqnest Type: P <br /> R ested B Subject of Data Not Subject of Data <br /> equ Y= <br /> Inf ormation Requ <br /> ested is Classifie�: �ublic Private <br /> Confidential Non-?ublic -rotected Non-Public <br /> A roved Denied Approved in Part <br /> Request is: PP <br /> Remarks/Comments: <br /> Authorized Signature: <br /> _ $ <br /> Fees:� x Total Due <br /> No. of Pages Rate per Page .. <br />