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ORONO ADMSNIS��TI� �FF=�S <br /> rI�7E'ORMATION DISCLOSIIRE RE4IIEST <br /> HINNESOTA Ga DATA PR�CTICES ACT <br /> ' gEQIIESTLR NOTE: <br /> A, Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, <br /> the <br /> data need not be disclosed to you for six months thereafter <br /> unless a dispute or action is pending or additional data -on <br /> you has been coll.ected. <br /> B. you may be reauired to pay actual costs in makinq, <br /> certif ying and%or compiling the copies oi insormation <br /> requested. � <br /> Date of Request: <br /> , � � ^� ����' -�--- <br /> Requester Name= c' e <br /> p y: 1�,� c� Ll L �``��1 <br /> Address: �. (�' ! � � � c� S��- cit <br /> z�P- ��� � � � <br /> Business- � ��c `� � �' -� � <br /> gome Phone: ,� <br /> � ested: � U� � G� i �1 � � �P� w► i , 5 <br /> Description of Information Kequ <br /> ��c�C� l �� . <br /> � , ,v,� <br /> Requestes`. s Signature: <br /> C � � <br /> BELOW INFORMATION TO BE FILLID IId BY DEPARTMENT ONLY <br /> Handled By: <br /> Department= <br /> Request Type: _In person <br /> Mail Phone <br /> Subjec� o= Data Not Subject of Data <br /> geqzaested By: ` <br /> Inf ormation Requ <br /> ested is Classified: ?ublic _Private <br /> Confidential Non-�ublic =rotected Non-Publi.c <br /> gequest is: <br /> Aporoved Denied Aaproved in_Part <br /> Remarks/Camments: <br /> Authorized Siguat�re: <br /> _ $ <br /> Fees:� X Total Due <br /> No. of Pages Rate per Page <br />