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ORONO ADMTNSS�RATSY�' OFFSCES � <br /> 1�7FORMATION DISCLOSURE RESZ�ST _ <br /> • � �NN'ESOTA Ga DATA PR�CTICES ACT , <br /> • gpQUESTER NOZ`E= <br /> A. gequest Frequency - P?'iv�.te D�t� on individuals. ��ter th� <br /> have been supplied the aata and ouf Qo esixf noncnse hereafter - <br /> data need not be disclosed to y <br /> . .unless 'a dispute or action is -pendiaq or additional data -on <br /> you .has been col.Zected. _ <br /> . you may be reauir�ec to pay��actuzl cos�s in making, <br /> B and%or compiling zhe cogies o� in=oraztiOr <br /> certif ying <br /> requested. I ' <br /> Date of Requ <br /> est: �� � / <br /> r ' <br /> Requester Name: <br /> N� City: <br /> p,r3dress: � <br /> � zzn: SS.3 � �(--ZZ -� � -- <br /> �� j �� Business: <br /> g�e Phone: <br /> Descrip'�on of �O�a�'On Retru <br /> este3: � <br /> � Recraester'. s Signature: <br /> Bg�,OW =27gORMATION TO BE FYI.I�ED IH BY DEPARTl'�=NT ON�Y <br /> .� 4� � $andled sY= <br /> D ep art-�.ent: �' <br /> MaiZ Phone <br /> geqv.est Type= ��—In pe'-"son . — — <br /> Subj a= Dzt� � Not Sub� <br /> ec� o= Data <br /> gequested By= — ec� — <br /> :/ �uDlic _Pri.vate <br /> T��o�at.on Requested is Classified: — <br /> =rotected Non-Publ.ic <br /> Nan-?ublic — . <br /> Conf idential. — � Pa�. <br /> Denied � Anproved n_ _ <br /> gecmest is: '� Atioroved — � <br /> Re�arks�C��ts: <br /> �, <br /> - . , �---� �'_'' '� �'� <br /> Autb.or�-ze3 Signat�re: � . <br /> C �� _ $ <br /> x Totzl DLe .. <br /> Fees:• e5 g�te per Page <br /> No. of Pag . <br />