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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCI�OSIIRE KEQIIEST <br /> MINNESOTA GaVERNMBNT DATA PRACTICES ACT <br /> ° gEQIIESTER NOTEz <br /> A, Request Freauency - Private Data on individuals. Af ter you <br /> have been supplied the data and infor�ed of its meaning, the <br /> data need not be disclosed to you f or six months thereafter <br /> unless a dispute or action is pending or additional data -on <br /> you has been collected. <br /> g . You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies o= information <br /> requested. <br /> Date of Request: � � c� � <br /> � � ;��,��� �' ���t' .c� ��� <br /> Requester Names / /f <br /> � <br /> �) %; �' /� �",��ii�� �I 'ic-' C1t�7' %��� f,C-G'1GC � <br /> AddreSS: �� �ii /�l li� C�- ��`� <br /> ��— <br /> Zip: �E� � �. <br /> gome Phone: �� �� ��/ ? � Business: <br /> Description of Information Requested: <br /> . �� <br /> <_��,�'.� r , �.� G �. <br /> � �� � <br /> Requester' s Signature: '� <br /> `..� � ��c'- �-�' <br /> BELOW INFORMATION TO BE FII.LED IN BY DEPART�?NT ONLY <br /> Departsnent: <br /> Handled By: <br /> In erson Mai? Phone <br /> Request Type: P <br /> gequested By' Subjec� of Data Not Subject of Data <br /> Information Requested is Classified: <br /> �ublic Private <br /> Confidential Non-aublic -rotected Non-Public <br /> Re�est is: Approved <br /> Denied Aaproved in Part <br /> Remarks/Camments: <br /> Authorized Signature: <br /> _ $ <br /> Fees: x Total Due <br /> No. of Pages Rate per Page .. <br />