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OROl`i0 AD:��32STRATI:VE ��=�°S � <br /> 2NFORMATIO:Z D=SCLOSIIRE RE4�ST <br /> • � I�4SNI�ESOTA GO DATA PR�CTICES �CT , <br /> • ggQTTES�F�R NOTE= . <br /> A. p ecuest Freauency - Private Data on indiv�a���SIIe�ing, th= <br /> ha�-e been suppl.ied the aata and infQr�ed� o-Yon�s thereafter � <br /> nata ne�d not be disc?osed to ye� i�� or zaQit�onsl Qat� .�n <br /> . .un1ess :'a dispute or ac�ion is �p . � <br /> you .has bee� collectec. <br /> you m.ay be reauirec to pay��actual �cos�s in �akina; <br /> H. zhe copies or in=or�zt-Or <br /> certifying and/or co��iling <br /> requested. `�"/�� D - <br /> Date of Request: <br /> I> I <br /> . • r �C� <br /> � <br /> Recruester Name= , ''� ������'� <br /> . �,� U �� . Ci�v: U <br /> Add.ress- U ` <br /> � Z ip= . <br /> Business: <br /> game phone: � �--� <br /> Descr <br /> ' on f o ation R ested: � ' <br /> ,� � i . <br /> � Recrues�er'. s Si.gnature: <br /> BgyOW �pORMATION TO BE FII�LED IN BY DEPF��H� O�Y <br /> Handle=:. Fy: <br /> D ep ar`�.�.ent= <br /> Mai? Phone <br /> gec�uest TyPe= —xn Ferson . -- <br /> Subjec= o= Data No:. Suz��ec� of Data <br /> ge�ues�ed BY= — ` � <br /> _,.�I.;c _P�ivate <br /> �fo�ati.on Requested is Classified= — <br /> _rotected Nan-Publ.i� <br /> Con=idential tvo�-?ublic . _ . <br /> — -�nroved in Par� <br /> Aoproved Denied -- <br /> gecruest is= _ — <br /> Re:aarks/Coarments= <br /> - . �� _ .�._ ��._,.�••'�� _�'��` <br /> gn.�ori.ze3 Signature: �/ `� : ;.,- � <br /> -% `r� = S <br /> Fees:• X �o �er Fage Total Due „ <br /> No. of Pages Ra_- . <br /> . { <br />