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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQUESTER NOTE: <br /> A. Request Frequency - Private Data on individuals: After you <br /> have been supplied the data and informed of its meaning, the <br /> data needanot be orsclosed to you for acti n is pending or amonths <br /> d ti nal thereafter <br /> -on <br /> unless a dispute <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: L/� Jo/4/s 0 i <br /> / c....774-c....774- City: .5-7.e,.5-7.e, 4 L ice,A)),1, <br /> Address: `J���� <br /> zip: s� /-, <br /> Home Phone: 9a� - �o�` Business: <br /> Description of Information Requested: <br /> Requesters Signature: 4IP wee <br /> „6.1.1wr <br /> BELOW INFORMATION T! BE 'ILL:5'. IN BY DEPARTMENT ONLY <br /> Department: Handled By: <br /> Request Type: In person Mail Phone. <br /> Requested By: Subject of Data Not Subject of Data <br /> � <br /> Information Requested is Classified: Public Private <br /> Confidential Non-Public Protected Non-Public <br /> PP <br /> Request is: <br /> Approved Denied Approved in Part <br /> Remarks/Comments: <br /> Authorized Signature: hihirli , <br /> , = $ <br /> Fees: x 1Total Due <br /> No. of Pages Rate per Page .. ` <br /> 1 <br />