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ORONO ADMINISTRATIVE OFFICES <br />SNFORMATION DISCLOSURE REQUEST <br />MINNESOTA GO DATA PRACTICESACT <br />REQIIESTER NOTE: <br />A. Request Frequency - Private Data on individuals. After you <br />have been supplied the aata and informed of its meaning, <br />data need not be disclosed to you for six months thereafter <br />Bless :'a dispute or action is pending or additional data -on <br />you .has been collected. <br />you may be reauir.ed to pay actual costs in making. <br />B. cer .• and/or compilin the copies or inf,ora tion <br />s- .if Ying <br />requested. <br />�l j <br />Date of Request: <br />Requester Name: <br />City <br />Aaaress : <br />_lusiness: <br />Home phone: <br />Description of Information Requested:. <br />Requester's Signature: <br />BELOW INFORMATION TO BE FILLED IN BY DL'FAR .T ONLX <br />Handled By: <br />D ep went : <br />Mail Phone <br />Bequest Typ= e= In person. — <br />Suh4ecof Data Not Subject of Data <br />Req-aes-tZed. By:'Public —Private <br />Tnfornat_ .on Reque <br />sted is Classified: <br />_Confidential <br />Non -Public _=rotected Non -Public <br />Reclaest is: Approved <br />Denied Approved in_Part <br />Remarks/Cc�ents: <br />Anthon-zed Signatara= <br />= S <br />Fees: x Total Due . <br />No . of Pages Rate per Page <br />