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ORONO ADM=NISTRATNE 0�=�S � <br /> =NFORM�iTION DISCLODS��PR�I�S gCT <br /> • � IS23�7PTESOTA Ga , <br /> • gEQUESTER NOZ'E- . - <br /> g. Request Frequeacy - Private Data on individuals. ��er the <br /> have been suppbeeQi�losed to youf foresixf man�:nsehreafter � <br /> data need not <br /> � .unless ��a dispute or ac�ion is -pending or adaitional data -on <br /> you .has� been col.lected. � � <br /> H. yQu may be required to .pay�'actual cos�s in making, <br /> certif ying and/or compiling the cooies of iaf ormation <br /> requested. - <br /> , <br /> Date cf Reques�t: - � � � <br /> . - � �� ..r 7/ �K �✓ �v,.f l-.c/t�-G� <br /> Reqaester Namez <br /> 3� I' ���� ,r� r<•t <br /> .� � : .�_,�,�-_ City: �� . <br /> p,ddress: � <br /> . . s�3 s� <br /> Zip� <br /> a�� thone: <br /> �� _y7� � o�1 S� Busiaess: 9�Z- �l' 7'�' ��2� <br /> Descriptian of Iaformatioa Retruested: <br /> .� �� l �� l 7 G s�i,�� �� �-e. <br /> �c <br /> � Rea-aester'. s Signature: <br /> BgyOW ='NgORMATION TO BE FII�LF•D IN BY DEPARZ'MEZIT OI�TLY <br /> � Handled By- � <br /> Depart��t= �"r <br /> Mail Phone <br /> gequest Type= In person . — — <br /> Not Subject of Data <br /> gequested By= _Subjec� of Data , <br /> T�fo�ation Rec�a <br /> ested is Classified: �ublic Private <br /> Noa-?ublic =rotected Noa-Public <br /> Canf idential _ . � ---- <br /> Denied � A�proved in_Part <br /> ge�c�aest is� =�Proved __ --- ' . ` <br /> Rem.arks/Cammie�ts- <br /> Aathorized Sig�'t�e: � <br /> _ $ <br /> Fees:• x Total Due ._ <br /> No. of Pages Rate per Page <br />