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ORONO ADMSNISTR.ATIYE ��=�S ' �TFORMATION D2SCLOSURE RESZ�ST • � �iI�INESOTA GO DATA PR�CTICES ACT , • gEQ17ES� NOZ`E- . A, gequest Frequenc� - Private Data on individuals. �te= �°�u� h�.�-e been supolied the aata and ouf fQ esixfnon'�r.'nsethereafter � datz. ne�d not be disclosed to y . .unless :�a dispute or ac:.ion is �pending or additional data -on you .ha.s bee� col.lected. � you may be reauired to pay ��a�tuzl cos�s in �akinQ� B. zhe cooies or inforaatior_ certifying and/or co�piling requested. `//�� D • � � Date of Req�est: • • �C/ i � ReQuuester Name= ' �����`J - �,-, � , City: p.r3dress- C� ` � Z i�: � Business: H�.e Phane: � � j Descr � on f o ation R _ ested: '"�'� ,% / J - � Re�su.es�er'. s Signature: BgyOW =NFORMATION TO BE FII.�I�E� IN BY DEPAR�'�� O�Y Hancclea sy: Depar;"�.ent: Mail Phone gequest Type- —sn person . — — ge�zes�ed $Y= — Subjec� o= Data Not Subjec� o= Dz�� =�o�at; on gequested is Classified= �u:olic _Private Conf idential Na�-?ubli.c ,="rotected Non-Public — P_�nroved irs Part Aooroved Denied -- gecruest is: _ — Re�ar�s�Comments: ` �7 /. � - . G j�'� �' '�,.. �, -;:�� Anthorized Signatare: `� '� ,; . .i� � _ $ Fees:• X ' Tota1 Due _, No. of Pages Rate per Faqe . { ��� �^-// v j, r 1� y � ����`,�'�- ` � " � � �;. �4v.. � / �� �--,; � ��r S ��� �� �� 5S . � � � � 3�7 � � a� . , � � 0 3`5 �z.�-� _ � �� ��� l � � � �c� �-�° , � � e �� ���� ��� � � l ✓ � �o ���� � �-�- �� � — � � � � � � �s �� ���� � �.� �� S� � � O � � � 1� � � �� � � ^ f �. � � �� a � �.�e., �2, ✓ � � _ - �� - � �. _ � � . �� � � . � . ��. � �� �� ✓ � �� � � �� � . � � s _ ��� ' ,�° � � I � ��-�