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ORONO ADMINISTRATIVE OFFS�S <br /> I3�FORMATION DISCLOSIIRE R�Q�ST <br /> MINNESOTA Ga DAT� P��ICES ACT <br /> ggQUESTER NOTy� on individua?s. After you <br /> A, Request FrequencY - Przvate Data <br /> the <br /> have been supplied the data and uf=or esix montnsethereafter <br /> data need not be disclosed to y <br /> un1ess a dispute or action is pending or additional aata -on <br /> you has been coZlected. zcttzal costs in making. <br /> B , you may be reauired to paY <br /> certif ying ar_d%or compi ling <br /> �re copies oi in=ormat�on <br /> requested. � <br /> Date of RequeSt= l� 3`�S� <br /> , ���'[�i"� 6�t �--- <br /> Requester Name: i,,A-��, <br /> /�o.�J c3.ty: ��t <br /> p,ddress- �� �`�� <br /> z ip - v�s��� <br /> e_ �'3` ZZZ-- Business- -377��l�/ <br /> aom� rh•= - <br /> Description of Inf ormat�on R�ueste�: <br /> �3 g �'�c�Iz Y �'/�-- <br /> Rec3uester' s Sign <br /> ature: Gf.`t <br /> BgyaW TNgOgMATION TO BE FII,.LE� <br /> , B DEPARTMSNT ONZY <br /> gandlet3 BY= <br /> Departme.nt= <br /> Reqc�est Type: _In perscn <br /> Mai� Phone <br /> Not Subjec� of Data. <br /> gequeste� By= — <br /> Subje�� o= Data — <br /> Infotmation Requested is Classified: <br /> �ublic —PrzVa`e <br /> Nor.-�ubZ=� =rotected Non-PuDlic <br /> Conridential __ <br /> Rer�uest is: ApDroved <br /> Denie� Approved in Part <br /> Re�ar3�cs/Ca��ts= <br /> Aut�iorize� Signature: <br /> _ $ <br /> X Total Due <br /> Fe�s: g Rate per Fage " <br /> No. of Pa es <br />