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ORONO ADMINISTRATIVE ��=�S <br /> =NFpRM�1TION DISCLOSIIRE �Q�ST <br /> MINNESOTA Ga DATA PR.ACTICES ACT <br /> REQIIESTER NOTE- <br /> A, Request Frequency - Private Data on individua?s. Af ter Y°u <br /> have been supp1ied the data aod ufOoresi�fmontnsethereafter <br /> data need not be disclosed y <br /> unless a dispu�e or action is pending or additional ciata -on <br /> yQu has been col.lected• zC`ual costs in naking, <br /> B . You may be required to p�Y t'r.e copies o� inzormat�or. <br /> certifying ar_d/or corRPiling <br /> requested. l . ` <br /> a <br /> �_r - l � . <br /> Date of Request: ` � , �"� � _� � - � '�� '�� -_� <br /> ` � r _� ;_ � � ' � ; , .G' % �� <br /> Reqaester Names � �ty: ' � �s �� �� �� � �� . <br /> _ ,� _ i � f-� f�, <br /> Ar3dress. <br /> ZiD - � � � � _ �' �� -�;% '�� � <br /> -, �; ', <br /> L� -i` _ ' B11SlIleS S � - - <br /> H�e Phone: ' ' _ <br /> ��_ � � <br /> � <br /> . �. <br /> - - �. , �,� ���_ <br /> Description of Informat�.°II R�Tuested: � " <br /> � � , r � � <br /> � � <br /> �. , <br /> � <br /> , <br /> � " h f , � <br /> �e�uester' s Signature: _ <br /> ( `:( �� � <br /> Bg�,OW INgORMATION TO BE FI� I� BY DEPART*�-ENT ONLY <br /> Handled Bv: <br /> Departsue-nt= <br /> �ayz Phone <br /> Request Type= _Tn Pe'-"scn <br /> Subjec� or" Data <br /> Not Subject of Data <br /> Retruested By= — <br /> Tnformation Requested is Classifie�: <br /> =ublic _Private <br /> Non-�uD1=c =rotected Non-Punlic <br /> Consicential — <br /> Denied �pproved in Part <br /> Request is: Approved __ <br /> Remar3ts/Camments: <br /> Authorized Signature: <br /> = S <br /> X Total Due <br /> Pe�s: eS Rate per Page '- <br /> No. o= Pag <br />