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You have the right to choose what data we release. This means you can let us release all of <br />the data, some of the data, or none of the data listed on this form. Before you give us <br />permission to release the data, we encourage you to review the data listed on this form. You <br />ave the ighi jo lei us relea�e he d ji jj ill. j jjj oi j*Le.*f th� Qejsjjc—*j <br />what data they may receive. <br />the data. You may withdraw your permission at any time. Withdrawing your permission <br />will not affect the data that we have already released because we had your permission to <br />release the data. <br />langirm"s <br />1, , give my permission for the City of Lake Elmo to release <br />data about me to as described on this form. I understand that <br />my decision to allow release of the data to is voluntary. <br />1) <br />The specific <br />data <br />that <br />the City <br />of <br />Lake <br />Elmo <br />may <br />release: <br />2) <br />1 understand the <br />City <br />of Lake <br />Elmo wants <br />to <br />release <br />the data <br />for this <br />reason: <br />3) 1 understand that although the data are classified as private at the City of Lake Elmo, <br />the classification/treatment of the data at depends on laws or <br />policies that apply to This authorization to release the data <br />expires on <br />Individual data subject's signature <br />Date <br />