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• <br /> • <br /> ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE REQUEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQUESTER NOTE: individuals.. After you <br /> A. Request Frequency - Private Data on indou <br /> have been supplied the data and informed ix of themtshseahereaft <br /> data need not be disclosed yending or additional data -on <br /> ou unless a dispute or action is p <br /> you has been collected. actual costs in making, <br /> B. You may be required to pay <br /> certifying and/or compilitre copies of information <br /> ng <br /> requested. <br /> Date of Request: ��� �� <br /> Requester Name: C <br /> Address: / <br /> .(R-)r- dam° 0,4,--) 4 city: v /2 <br /> zip: ______,ELLL____________ <br /> Business <br /> gee Phone: <br /> Description of Information Requested: <br /> Requester` s Signature: <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled BY= <br /> Depar gent <br /> In person <br /> Mail —phone <br /> Request Type: — <br /> Retrnested By: _Subject of Data <br /> Not Subject of Data <br /> Information Requested is Classified: <br /> Public _Private <br /> Confident'al <br /> Non-Public Protected Non-Public <br /> Request is: Approved __ <br /> Denied Approved in Part <br /> Remarks/Comments: <br /> Authorized Signature: <br /> x Total Due <br /> Fees: Pages Rate per Page <br /> No. of <br />