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ORONO ADMINIS�R.ATIVE OFFSCES <br /> INFORMATION DISCLOSURE REQIIEST <br /> MINNESOTA Ga DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A, Request Frequency - Private Data on individuals. After the <br /> have been supplied the data and informed of its meaning, <br /> data needdistute orsaction is pending or additional edatat�on <br /> unless a p . <br /> you has been collected. <br /> B, You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies or iniormation <br /> requested. <br /> Date of Request: � - ��~ 7?� <br /> Requester Name: w���'�`� ��� � <br /> Address: �� <br /> (�� ��� �<�'L-�-�-`� City: `�'C`��--�-e-�= . <br /> z�p: �53"�� <br /> Home Phone� ��7 �- �U�--- Business: � �D " �� -- <br /> Description of Information �Zequ <br /> este�: �-��>��� -��� i 5 <br /> , � �.L,�� <br /> .a.r� � ��'/�- ',,� `a _ <br /> �-i � <br /> 4-4-L 7' 12..�.�� �� <br /> , �_ <br /> Rer�uester' s Signature: - <br /> gEI,OW INFORMATION TO BE FII,I,ED IN BY DEPARTMLNT ONLY <br /> Handled By: <br /> Department= <br /> Request Type: <br /> In person Mai1 Phone <br /> Re�uested By= <br /> Subject o= Data Not Subject of Data <br /> Information Requ <br /> ested is Classified: ?ub1=� Private <br /> Confidential Non-Public =rotected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> RP�arks/Comments- <br /> Authorized Signatures <br /> _ $ <br /> Fees: X Total Due <br /> No. of Pages Rate per Page :- <br />