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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE PRACTICES STACT <br /> MINNESOTA GO <br /> REQUESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After the <br /> ou <br /> have been supplied the data and informed iof x months thereafter <br /> meaning, <br /> h <br /> data need not be disclosed to you <br /> unless a dispute or action is pending or additional data -on <br /> ` , <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: 0 3 r <br /> Requester Name: <br /> Address: <br /> UOC7 1. - L 4 -1- GI.. ; foo City: I`nPL< <br /> Zip: S 5210 <br /> Business: �la1l5_ y��`3 <br /> Home Phone: 1 <br /> Description of Information Requested: <br /> lc lik. S-` CPQ a__ <br /> . ° 1- - 1-r > <br /> Requester'. s Signature: is - -t' = <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Bequest Type: _____In person <br /> Mail. Phone <br /> Subject. of Data <br /> Not Subject of Data <br /> Requested By: <br /> Information Requested is Classified: <br /> Public _Private <br /> Non-Public Protected Non-- <br /> public <br /> Confidential — i n Part <br /> Request is: Approved <br /> Denied Approved __ _ <br /> Remarks/Comments: <br /> Authorized Signature: (Z04-4j C--(A.J.^4----. <br /> Fees:. xTotal Due , <br /> No. of Pages Rate per Page <br />