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ORONO ADMINISTRATIVE �FFI�S <br /> INFORMATION DISCI,OSU�E REQIIEST <br /> MINNESOTA Ga 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, <br /> the <br /> data ne�d notube orsaction is pending or add ti nal edata -on <br /> unless a disp . <br /> you has been collected. <br /> B, you may be reguired to pay actual costs in making, <br /> certifying and/or compiling the copies of insormation <br /> requested. <br /> Date of Request: � �� �� <br /> ; r ;� ��� <br /> Requester Name: t � /�- �� � � � ` / / <br /> / ( � � �,.� G �'� city: Gi/�� ��� <br /> Address: � .� (� � <br /> z�P: � �j� ��l .� -� <br /> Home Phones <br /> Business: % ��G% ���� <br /> Description of Information Requ <br /> este�: � ��� -��(,� — ����� �,�� <br /> � � _ J� �l z� ���� ,�'1 —C��-v <br /> c �, <br /> ;� � � �� , <br /> Requester' s Signature: � � � ��`� <br /> BEZ�OW INFORMATION TO B FILLED IN BY DEPARTML'NT ONLY <br /> Handled Bys <br /> Department: <br /> Request Type: <br /> In person Mai1 Phone <br /> g ested B Subject oz Data Not Subject of Data <br /> � y: <br /> Information Requested is Cl�ssified: <br /> Public Private <br /> Confidential Non-?ublic =rotected Non-Public <br /> Request is: Approved Denied Approved in Part <br /> Remarks/Comments: <br /> Authorized Signatnre: <br /> _ $ <br /> Fe�s: x Total Due <br /> No. of Pages Rate per Page .. <br />