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ORONO ADMINI+TRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA G0, 51- I ' . DATA PRACTICES ACT <br /> • <br /> REQUESTER NOTE: <br /> Frequency - Private Data on individuals. After'you <br /> A. Request q Y the <br /> have been supp�lied the dahta and informed iof x mics meas ng,thereafter <br /> data need not ;be disclosed to y for <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: i''//?f`1 CI <br /> Requester Name: #150_ ,e,, 7/64_,... r'�Address: .2'17 7 �.. .� City: OFaYt <br /> Zip: 57133 <br /> 1/7,2,3 y Business: 1/7/—07.22 <br /> Home Phone: 3 � <br /> Description of Information Requested: <br /> ,- 7'y 1; 2 r o/4 j ;y ¢�/ 8.7 Xi <br /> Requesters Signature: /V-G -€271. <br /> BELOW INFORMATION TO B4OILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Request Type: <br /> In person Mail Phone <br /> Requested By: <br /> Subjec� of Data Not Subject of Data <br /> Information Requested is Classified: Public Private <br /> _Confidential Non-Public Protected Non-Public <br /> Request is: Approved roved Denied Approved in Part <br /> +-- <br /> Remarks/Comments: <br /> Authorized Signature: <br /> Fees: xTotal Due <br /> No. of Pages Rate per Page <br />