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Page 14 of 22 <br />C i t y o f L a k e E l m o D a t a P r a c t i c e s P o l i c y 2026 <br />City of Lake Elmo <br />Data Request Form – Data Subjects Date of request: _____________ <br />To request data as a data subject, you must show a valid state ID, such as a driver’s license, <br />military ID, or passport as proof of identity. <br />I am requesting access to data in the following way: <br />⎕ Inspection ⎕Copies ⎕ Inspection and copies <br />Note: inspection is free, for copies we charge $0.25 per page for up to 100 pages ($0.50 two <br />sided up to 50 pages) or employee time, the cost of the materials onto which we are copying <br />the data (paper, CD, DVD, etc.), and mailing costs (if any). If your request is for copies of data <br />that we cannot reproduce ourselves, such as photographs, we will charge you the actual cost <br />we must pay an outside vendor for the copies. The cost of employee time to make copies is <br />calculated at the actual hourly rate of the employee. <br />Description of data requested: <br />Note: Describe the data you are requesting as specifically as possible. If you need more space, please use the <br />back of this form. <br />Contact Information <br />Data subject name______________________________________________________________ <br />Parent/Guardian name (if applicable) _______________________________________________ <br />Address______________________________________________________________________ <br />Phone number_____________________ <br />Email address________________________________ <br />Signature of Data Subject or Parent/Guardian_________________________________________ <br />Staff Verification <br />Identification provided___________________________________________________________