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ORONO ADMINISTRATIVE OFFICES <br /> INFORMATION DISCLOSURE <br /> PR�AC PRACTICES ACT <br /> MINNESOTA GOVERNMENT <br /> • <br /> REQUESTER 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 Yu for siamonths <br /> d ti nal edata -on <br /> reafter <br /> unless a dispute or action is pending or <br /> you has been collected. <br /> B. You may be required to pay actual costs in making, <br /> certifying and/or compiling the copies of information <br /> requested. <br /> Date of Request: (- • n G1 <br /> Requester Name: A ' k- A1-- OA) <br /> Address: 100 o Q(t.c—lases <br /> City: ___Q171.2152___ <br /> Zip: <br /> Home Phone: <br /> 22. 2'1 Business: <br /> � "1 <br /> Description of Information Requested: <br /> , 1 1 —Or <br /> Requesters Signature: 111111MNIEF <br /> BELOW INFORMATION TO BE FILLED IN BY DEPARTMENT ONLY <br /> Handled By: <br /> Department= <br /> Request Type: In person <br /> Mail Phone. <br /> Requested By: <br /> Subject of Data Not Subject of Data <br /> Information Requested is Classified: Public —Private <br /> Confidential <br /> Non-Public Protected Non-Public <br /> Approved Denied Approved in Part <br /> Request is: PP — <br /> Remarks/Comments: <br /> Authorized Signature: <br /> Fees: x Total Due <br /> No. of Pages Rate per Page <br />