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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE <br /> PREQUEST <br /> C PRACTICES ACT <br /> MINNESOTA GOVERNMENT <br /> • <br /> REQUESTER NOTE: • <br /> A. Request Frequency - Private Data on individuals. • <br /> After ou <br /> have been supplied the data and informed <br /> ofx laitshsmeaning, <br /> thereaft the <br /> data need not be disclosed to you <br /> r <br /> unless a dispute or action is pending or additional data -on <br /> ou has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> . <br /> Date of Request: ,1z - GG�j <br /> Requester Name: v ' hi '2 ' <br /> Cit 4LL s . l n z, _ <br /> Address: 3� . � �irrp "` <br /> zip: 5 LLE_ <br /> awe Phone: <br /> /' ll.'., G f Business: _f_25_::12:12_1___ <br /> Description of Information Requested: <br /> llir <br /> Requester'. s Signature: A��,� <br /> � <br /> . IN BY DEPARTMENT O •Y_,_ <br /> BELOW INFORMATION TO :E FILL' <br /> Handled By: <br /> Department: <br /> Request Type: _In person . <br /> Mail Phone <br /> Requested By: <br /> Subject. of Data Not Subject of Data <br /> Information Requested is Classified: Public Private <br /> Confidential <br /> Non-Public _ protected Non-Public <br /> Approved Denied Approved in_Part <br /> Request is: <br /> Rema rks/Comments: <br /> Authorized Signature: <br /> Fees:- x Total Due <br /> No. of Pages Rate per Page <br />