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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GOVERNMENT DATA PRACTICES ACT <br /> REQIIESTER NOTE: <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, 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 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 /> Date of Request: �i? �d'� f � � <br /> Requester Name: ��� \ / � <br /> ,�Address: � .3' � �� � � ' � City: ' �, •� <br /> Zip: � C.�� ' ) <br /> Home Phone: ����� �� a �^7� Busines s: �"� ` � � � I 1 �� <br /> Description of Information Requested: � �� �e � V11t l <br /> r � ) � � 1 �f-:� ,- <br /> . <br /> �� �' Z��+ ��� � � �, Z —' � � �� � � �;� <br /> n , � �� � <br /> 1'�, cL � .� a- �., �--n_ ' � <br /> Requester' s Signature: <br /> �� � � �� � <br /> BELOW INFOItMATION TO BE FILI�ED IN BY DEPA� ONLY <br /> \ . ,� <br /> Department: � '��- Handled By: <br /> Request Type: pL In person Mail Phone <br /> Requested By: Subject of Data r�_Not Subject of Data <br /> Information Requested is Classified: �Public Private <br /> Confidential Non-Public Protected Nan-Public <br /> Request is: �Approved Denied Approved in Part <br /> Remarks/Comments: <br /> Island:474-1958 Homc: 892-7876 <br /> Authorized Signature: ,�„— Board of Governors <br /> Big Island Veterans Camp <br /> Fees: x Disabled American Veterans <br /> No. of Pages Rate per Page Representative <br /> Patrick K. Healy <br />