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Aug 23 99 12: 19p Cit of Columbia Heights 612-782-2801 p. 12 <br /> Exhibit 2 <br /> • <br /> CONSENT TO RELEASE PRIVATE DATA <br /> I, , authorize the City of Columbia Heights ("City") to <br /> (print name) <br /> release the following private data about me: <br /> to the following person or people: <br /> The person or people receiving the private data may use it only for the following purpose or <br /> purposes: <br /> This authorization is dated and expires on <br /> The expiration cannot exceed one year from the date of the authorization,except in the case of authorizations given in connection <br /> with applications for life insurance or noncancelable or guaranteed renewable health insurance and identified as such,two years <br /> after the date of the policy. <br /> I agree to give up and waive all claims that I might have against the City, its agents and <br /> employees for releasing data pursuant to this request. <br /> Signature <br /> IDENTITY VERIFIED BY: <br /> o Witness: <br /> o Identification: Driver's License, State ID, Passport, other: <br /> o Comparison with signature on file <br /> o Other: <br /> Responsible Authority/Designee: <br />