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ORONO ADMSNIS�R.ATSQE OFFICES . <br /> INFORMATION DISCLOSURE R�4�ST <br /> MINNESOTA Ga DATA PRACTICES ACT <br /> �Q�S� N�� - Private Data on individual.s. ��er the <br /> A. Request Frequency <br /> have been supplied the data and ouf fo esixf monthsethereafter <br /> data aeed not be disclosed tO yending or additional data �n <br /> unless a dispute or action is p <br /> you has been collected. <br /> be required to pay actual costs in making, <br /> g, you may t'r.e copies o= information <br /> certif ying and/or compiling <br /> requested. � <br /> Date of Request: � <br /> �ll�t-s�' � � � <br /> � ���a� ���_ <br /> Requester Name s �i�Z<;� sC/� '�"T ( '- �E �Ii} /� . <br /> � Gj�ty: /�%��� <br /> Address: l��_ �`^� `� <br /> zip: -S^5���� a - 760 0 <br /> � 2� Business: � 7 <br /> H�e Phone: ��� �" � � - <br /> Description of Inf°�a�'oa Re�qneste�.: <br /> �rat�i I � S N�dt-`�/S �_�� <br /> Requester: s Signature: <br /> BgI,OW TNBORMATZON TO BE ILLED IN BY DEPART�T ONLY <br /> �,�Z Handled BY= <br /> Department: <br /> Mai? Phone <br /> gequest Type: �_In persan — <br /> Requested By: Subj <br /> ec� of Data _�,Not S'�b7ect of Data <br /> ���Zi� Private <br /> TnfoZmation Requeste3 is Classified: -- <br /> Noa-�ublic =rotected Non-Public <br /> Confideatial — <br /> geqnest iss �Approved <br /> Denied Approved in Part <br /> gemar�s/Comments: <br /> Authorized Sigaature: <br /> = S <br /> x Total Due <br /> Fe�s=� No. of Pages Rate per Page •- <br />