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ORONO ADMINISTRATIVE �FFI�S <br /> INFORMATION DISt�OSiTRE REQIIEST <br /> I�+iINNESOTA Ga DATA PRACTICES ACT <br /> REQIIESTER NOTE: • <br /> A, Request Frecuency - P�ivate Data on individua?s. After you <br /> have been supplied the data and informed of its meaning, the <br /> data needanstube oTsaction is pendina or add tional edatat�on <br /> unless a p . <br /> you has been collected. <br /> B, You mav be reQuired to pay actual costs in making, <br /> certifying and/or compiling the copies oz inior�atior- <br /> requested. <br /> > - <br /> Date of Request: ',� r' <br /> � � .,r,t" �17 T ' � �i''Y�. ry� �.� ;�✓`f� ,`rw..a:.� <br /> Requester <br /> Name: !- �,j-�. �_ �,�,�- -1'; <br /> r,% <br /> Address: ��� . ���' �, �y " �; ����� s r � :,,�. City: r� � . w� <br /> Zip� " % r' , _ <br /> •- �= , y-��y� , <br /> game Phones <br /> Business : ��;, ;"- _. �_.; � � <br /> Description of Information Requ <br /> ested: l� � ,� �1 � �f - r',�� j`�� ; ' � , <br /> , ,. � j r (� . �•r <br /> y -r. i 1 7 ��� 1'!�J'. �_�'• <br /> 'R 1: ^ 1 �'., l�.�.!!^�y. : � <br /> 'f'-'� (1-.�`) `!' v <br /> . ' ,..� ! ^ . . <br /> � � (t i. A �.k I'� Y.� ,1 <br /> . d �� �\ <br /> Requester' s Signature: �. - _ <br /> BgyaW INgORMATION TO BE FSI,I,ED IN BY DEPARTMLNT ONLY <br /> Handled By: <br /> Department: <br /> In erson Mai? Phone <br /> Request Types P <br /> R ested B Subject or" Data Not Subject of Data <br /> � y: <br /> Information Reuuested is Classified: <br /> ?ublic Private <br /> Confidential Non-PubZi� =rotected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> Remarks/Comments- <br /> Authorized Signature: <br /> _ $ <br /> Fees:� X Total Due <br /> No. of Pages Rate per Page �- <br />