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ORONO ADMINISTRATIVE OFFICES • <br /> =NFORMATION DISCLOSURE <br /> • MINNESOTA CODATA PRACTICES ACT <br /> • <br /> REQ17ESTER NOTE: . <br /> A. Request Frequency - Private Data on individuals. After you <br /> he <br /> have been not be <br /> he data and closed to youf fored sixf its monthse thereafter • <br /> data need not be �, or additional data -on <br /> .unless :'a dispute or action is pending <br /> you .has been collected. <br /> you may be required to pay 'actual costs in making: <br /> B• the copies of information <br /> certifying and/or compiling <br /> requested. • <br /> � <br /> Date of Request: d/ <br /> Requester Name: Cfr r E_i? - ' c` . <br /> City: /� 15 <br /> Address: G • e co►2 . <br /> zips � ' <br /> � � ' ' c7/Home Phone: .. ��/ 'x`77 Business: � <br /> Description of Information Requested: <br /> r (V; /ci tr's/` <br /> -!J c.,...; '‘7.--.._ C� r' ' .‘ <br /> WO <br /> Requester's Signature: <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department: <br /> Mail Phone <br /> Bequest Type: __In person — — <br /> Requested By: <br /> Subject. of Data Not Subject of Data <br /> Information Requested is Classified: <br /> Public _Private <br /> Confidential <br /> Non-Public _Protected Non-Public <br /> Request is: Approved <br /> Denied Approved in_ t <br /> Par <br /> Remarks/Comments: <br /> • <br /> Authorized Signature: . <br /> = S <br /> Fees: x Total Due <br /> No. of Pages Rate per Page <br />