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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GoVERMMNT DATA PRACTICES ACT <br /> REQUESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After tn� <br /> have been supplied the data and informed of its meaning, <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data -on <br /> you .has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Request: <br /> Requester Name: <br /> Address: <br /> ���Q ti City: <br /> zip: <br /> &(a q"73 -�o�(l-3 Business: ( oZ q-7'S` <br /> Home Phone: <br /> Description of Information Requested: <br /> as © Al <br /> Requester's Signature: <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Department: <br /> Q E 2 Handled By: <br /> Request Type: 0` In person Mail _Phone <br /> Requested By: <br /> Subjec- of Data k, Not Subject of Data <br /> Information Requested is Classified: _P�_Public _Private <br /> Confidential Non-public protected Non-Public <br /> Request Par- <br /> is: Denied Approved in_Pary <br /> Remarks/Comments: <br /> Authorized Signature: <br /> Fees. x Total Due <br /> No. of Pages Rate per Page <br />