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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISGZOSDRE REQIIEST <br /> MINNESOTA Ga 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 nea distute orsaction is pending vr aaa�t�nal edatat�on <br /> unless P . <br /> you has been collected. <br /> g, you may be required to pay actual costs in making, <br /> certifying and/or compiling the copies o= in=ormation <br /> requested. <br /> Date of Request: � <br /> �� - � - � 1 <br /> , ` I '� (V �Ls�� <br /> Requester Name: <br /> Addre s s: 3��' 1-��- S�{"ov�E �I��� City: v t�"'--�" <br /> zip: � <br /> Home Phone: <br /> ��Z.- 20��}- Business : ��'��= <br /> Description of Information Requ <br /> ested: S��"-"` `� ��' ol � <br /> �/p�,.�b.r��- 6 U�v�.T 1 0.„� <br /> _ �/Re�uester' s Signature: <br /> gELOW INFORMATION TO BE FII,LED IN BY DEPARTMENT ONLY <br /> D epartsnent: <br /> Handled By: <br /> Request Type: <br /> In person Mai1 Phone <br /> gequested By- Subject of Data Not Subject of Data <br /> Information Requested is Classified: <br /> �ublic Private <br /> Confidential Non-Aublic =rotected Non-Public <br /> ges3uest is: Approved Denied Approved in Part <br /> Remarks/CQ��ts: <br /> Authorized Signature: <br /> _ $ <br /> Fees:� X Total Due <br /> No, of Pages Rate per Page .. <br /> �� <br /> � <br /> � � <br />