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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE <br /> DATA PRACTICES ACT <br /> MINNESOTA GO <br /> • REQUESTER NOTE: <br /> ' After you <br /> A. <br /> Rea_uest Frequency - Private' Data on individuals. the <br /> have been supplied the data and onf fa esixfmcnthsethe meaning, <br /> data need not be disclosed to y <br /> .unless :'a dispute or action is pending or additional data -on <br /> you .has~been• collected. a actual costs in making: <br /> B. You may be required to pay <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Requ <br /> est: A- 2r � <br /> Requester Name: <br /> Address: 91? /1 A -- <br /> S city: _4.1"___I___ <br /> Zip: . i/j _ "- l?fin _ <br /> Business: <br /> Home Phone: <br /> Description of Information R <br /> equested:. „L air�i ” <br /> / o / . . <br /> 5sr .G/G f o- o few...e w-.riD.+!! ' <br /> a �� , <br /> ' RegIIester'. s Signature:: EPART�T ONLY <br /> BELOW INFORMATION TO BE FILLED IN BY D <br /> Department: HandlDepartment: phone <br /> In person Mail Rest Type: — <br /> Subject of Data <br /> Not Subject of Data <br /> Requested By: �_ Public ac Private <br /> Information Requested is Classified: Pub -Public <br /> Non-Public Protected Non <br /> Confidential -- � _p, Part. <br /> Denied • Approved <br /> Request is: Approved Den <br /> --- <br /> Remarks/Comments: <br /> Authorized Signature: ' <br /> x <br /> No. of Pager Page Total Due <br /> Fees:* •, es Rate p <br /> • <br />