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OR02d0 ADMINISZ`RATIVE �FF=C�S <br /> INFORMATION DISCI,OSIIRE RE4IIEST <br /> MSNNESOTA Ga DATA PR�CTICES ACT <br /> ' gEQIIEST�R NOTE= <br /> A, Request Frequency - Private Dat informed1 ofditssmeaning, the <br /> have been supplied the data and <br /> data need not be disclosed to yending or add tional edatat�on <br /> unless a dispute or ac�ion is p <br /> you has been collected. <br /> g , YQu may be required to pay actual costs in making, <br /> certifying and/or compiling the copies oz in=ormation <br /> reguested. � <br /> Date of Request: <br /> 10 � ��— <br /> Requester Name: D � �! � � � <br /> � � ./�Y City: ����'�'l�> <br /> �' C��h���� ' <br /> Aaar�ss: �,��� <br /> �� / <br /> ti��_ �S ' � - -� <br /> c�-' ; ���� ��'� Business: � ��� �`� /� <br /> gome Phonez - <br /> C��i C(t:� i�GjcJr l'�. � � <br /> Descripti�= of I�ormation R�uested: ('C' <br /> i <br /> ;� <br /> � Re ester'. s Signature: �,� "r�i�l �'���`� <br /> � <br /> BELOW INFORMATION TO BE FII�I�ED IN BY DEPARTM�?NT ONLY <br /> Handled BY= <br /> Departsient= <br /> Request Type: In person <br /> Mai1 Phone <br /> Subjec�- o= Data Not Subject of Data <br /> gequested By= ` <br /> Inf ormation Re�a <br /> ested is Classified: �ublic Private <br /> Confidential <br /> Non-?ublic =rotected Nan-Public <br /> gequest is: <br /> A�oroved Denied Approved in Part <br /> Remarks/Co��ts- <br /> Authorized Signat�re: <br /> _ $ <br /> Fees:� x Total Due <br /> No. of Pages Rate per Page <br />