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�IU-� ` ' ` ' <br /> ORONO ADMINISTRATIYE OFFI�S C g� � � , , <br /> 2NFORMATION DISCLOSIIRE REQIIEST <br /> MIN�N�ESOTA Ga DATA PR�ICTIGES ACT <br /> ' REQIIES��R NOTE: . <br /> A. Request Frequency - Private Data on individuals. After you <br /> have been supplied the data and informed of its meaning, the <br /> data need not be disclosed to you for six montns thereafter � <br /> unless a dispute or ac�ion is pendina vr additional data -on <br /> you has been collected. <br /> g. You may be required to pay actual costs in making, <br /> certif ying and/or compiling the copies oi in=ormation <br /> requested. � <br /> Date of Request- <br /> , <br /> Requester Name: � , r � I <br /> x + � <br /> `� � � ,,� . City: D r� � � <br /> p�ddress: %� C: �C.� t ^ <br /> Z1p: � .> ;3 � r <br /> / l �- � � �����. � �-,..�„� � <br /> gome Phone: <br /> b [ � _ (��� -- 3 G U- BusiIles S: P i- � �:.�� v <br /> t-� ( I � �-4 � <br /> Description of Information Rea_ueste3: r �, � � ° ^ '� <br /> �j � � �� .� w . S+" �rn�wlc I"� � ,.1 .��.� e. � � <br /> VU� �i t�n� c . <br /> � `— i v `' <br /> -{-C,. ; �-v `r y . <br /> U "�' ar l/ .�r �s�nec � �^-� <br /> Reuaester'. s Signature: <br /> BFZOW INFORMATION TO BE FII,LED IN BY DEPART�NT ONLY <br /> Handled By: <br /> Departscent: <br /> geqnest Ty� <br /> e: In person MaiZ Phone <br /> g ested B Subjec� of Data Not Subject of Data <br /> equ I'' ` <br /> Inf ormation Requ <br /> ested is Classified: ?u�li� Private <br /> Confidential Non-?ublic =rotected Non-Public <br /> A�oroved Denied A�proved in_Part <br /> gequest is: _ <br /> Remarks/Camments_ <br /> � n L <br /> tnre: fJ {�'�`e L>��- .�'�: <br /> Authorized Signa j <br /> = S <br /> Fees:• x Total Due _. <br /> No. of Pages Rate per Page <br />