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� ' ' ATTACHMEN '� �(�Q�n� <br /> p �s ,..r <br /> CIT `�QN 2 O �t 1 <br /> ` Y OF ORONO � ,;: <br /> INFORMATION DISCLOSURE REQUEST �-.___._, <br /> Minnesota Government Data Practices <br /> A. :�JF'ST�2 �LETE (it 1- ) -_ � <br /> 1. Date of R�u�t _,L ;y ,�,_,_ AEOUESTER NOTE: • <br /> 2. Requ�ster Name (L�st, fir,$ , middle) • � � <br /> A. Fpue�t fr�Quenty—Priv��e D�ta on�nd�.;Cuafs.A'ter rou!►�.�peen� <br /> �'�� ���� ��v� , the c1�a anC inlorm�d of�ts mtsn:.�,IM O�a�eW no�0�O�u'oa�s b <br /> sia man►ns tne�u�ier un�ess�E��puu o�ac��on i�peneu�p w aaC.�w�w <br /> 3. AddL�25S (lf I�EEd@d) on yo�'+a�DN�co���tted, • <br /> � � /S� 8. You mty b�rspuireQ to pay tM�ctwt costs of makin0,tariifr�n9 anG�p <br /> tpmpd�n9 IA�top�ts OI�nformstipn rpu��teC. <br /> . Phane (if n�eded) �� - _ <br /> C/ s a'-7�c�5 cn C3"I-�j/ � Driver's License #�.����.5�7�-/y4 <br /> 5. D�s cripti� of the infonnat.ion requested '- <br /> �E/UEiPAL %Ui._:iF'ALC- O J'fLOC�K C3/cJ G�c����7`�, /��/ /t/d�H �.'�',�' •Y',-/-�� /�C/CLU.i�//(i( <br /> � _� <br /> l/1JT--d, cN S�'��c,r'� . S;�ov�i�/u�,4 iEie . i.�!S i �'/il/��✓ul� J���iy i i f�i�/� <br /> `7�"'__: --- - <br /> /�L-S/���%s�ii�it/� �?'v�� G� o��G'19'c�2%."� 04��c� <br /> 6.Reques r Signat <br /> � <br /> r� ---------------------�� M <br /> B. DEPAR OCNIPLETE , <br /> 7. Department: ' , �' '�_ 8. R�uested x�dled /1�Q� �T�,,r <br /> 9. Request Zyp�: In person Mail Phoa�e lO.Re�uested by: ,�i'�ub ect of Data . . <br /> Not s�ject of Dacta <br /> 11.Inf tion Requ�.sted is classfied: 12.R�quest: <br /> li c Non-publi c App�ved Deniecl Approved in Part <br /> Private Protected Non-p�lic (explain in 14) <br /> Confidential 13. Authorize'�-'�''� <br /> �ignaturn - � <br /> 14. REMAR�CS - C�]TS �" � <br /> ---------------------�� <br /> C. DEPARTMENI' CCMPLEI'E WHEN FEFS ARE ASSESSID (Reoeipt to be issued) <br /> 15. Fc-�s s Flat Rate X * 16. Fees-Researd�/Statmaxy <br /> # of Pgs Fees-Screening of Files <br /> *See current fee s dzedule <br /> 17. ZUI'AL AMOt7NT DUE $ Rec'd By Date <br /> - ---------------- --------- <br /> RFJQ�tJFSI'ER PLEASE NO'I'E ITII�iS � <br /> 1. Make money order/d�edc payable to City of Orono. <br /> 2.� If mai 1, return entire form and any fe�s to: <br />