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ORONO ADMINISTRA�"NE OFFICES <br /> INFORMATION DISCLOSIIRE REQIIEST <br /> MINNESOTA GO DATA PRACTICES ACT <br /> REQIIESTER NOTE: , . <br /> p,, Request Frequency <br /> - Private Data on individuals. After you <br /> have been supplied the data anci informed of its meaning, the <br /> data need nstute orsaction is pendi g 'or aaa ti nal edatat-on <br /> unless a di p , <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certif ying and/or compiling the copies of inf ormation <br /> requested. � <br /> Date of Request: �? 7-�� <br /> Requester Name: L�����'�'� <br /> Address: <br /> �p� _ � city: La� <br /> z�P: SS'�/ 3� <br /> Business: �� ' ��s� <br /> Hvme Phone: , <br /> Description of Information Requ <br /> ested: `� <br /> . <br /> Reqaester'. s Signature: <br /> EELpW INFORMATION TO BE FII.I+ED IN BY DEP�iRZ'MENT ONLY <br /> Handled By: <br /> Department: <br /> In person Mail Phone <br /> Request Type: — <br /> g ested B Subject vf Data Not Subject of Data <br /> � y: <br /> Inf ormation Requ <br /> ested is Classified: ?ublic Private <br /> Confidential Non-Public rrotected Non-Public <br /> Denied Approved in Part <br /> gequest is: Approved _ <br /> gem,arks/Cammeats: <br /> Authorized Sigaatures <br /> _ $ <br /> Fees:� X Total Due <br /> No. of Pages Rate per Page •- <br />