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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE PR QUISSTTS ACT <br /> MINNESOTA GOVERNMENT <br /> • <br /> REQUES'rr.K NOTE: <br /> A. Request Frequency - Private Data on wed of its mea ,Afte you <br /> have been supplied the data and informed <br /> data need not be disclosed to you <br /> additional <br /> _ending or addit onal s edatat-on <br /> actioner <br /> unless 'a dispute or is '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 of information <br /> requested. J - <br /> Date of Request: 6 117 r DO <br /> Requester Name: C - ' • <br /> Address: <br /> 1-{ 0 S -BY -w, City: 1-LI`1 D <br /> Zip: '���GI — <br /> Home Phone: <br /> &12 , (}7 3. 24N`D Business- <br /> Ve ; S � c---1,._,Description of Information Requested: k <br /> ' 0 (3)7U-91(-*` - <br /> Requester's Signature: J <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Mail Phone <br /> Request Type: —In person —`' — <br /> Subjec� of Data Not Subject of Data <br /> Requested By: <br /> Information Requested is Classified: Public _Private <br /> Confidential <br /> Non-Public Protected Non-Public <br /> Approved Denied Approved in_- <br /> Part <br /> Request is: — <br /> Remarks/Comments: <br /> Authorized Signature: ' /JLu-�.�� <br /> / <br /> Fees:. xTotal Due <br /> No. of Pages Rate per Page <br />