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Exhibit 4 <br /> CITY OF MOUNDS VIEW <br /> INFORMATION DISCLOSURE REQUEST <br /> Minnesota Government Data Practices Act <br /> A. Completed by Requester <br /> REQUESTER NAME(Last,First,M.): DATE OF REQUEST: <br /> STREET ADDRESS: PHONE NUMBER: <br /> CITY, STATE,ZIP CODE: SIGNATURE: <br /> DESCRIPTION OF THE INFORMATION REQUESTED: <br /> B. Completed by Department <br /> DEPARTMENT NAME: HANDLED BY: <br /> INFORMATION CLASSIFIED AS: ACTION: <br /> ❑PUBLIC ❑NON-PUBLIC ❑APPROVED <br /> ❑ PRIVATE ❑ PROTECTED NON-PUBLIC ❑ APPROVED IN PART(Explain below) <br /> ❑ CONFIDENTIAL ❑DENIED(Explain below) <br /> REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br /> PHOTOCOPYING CHARGES: IDENTITY VERIFIED FOR PRIVATE <br /> ❑NONE INFORMATION: <br /> ❑ IDENTIFICATION: DRIVER'S LICENSE, <br /> ❑ Pages x 0= STATE ID,Etc. <br /> Pages x 0= ❑ COMPARISON WITH SIGNATURE ON <br /> ❑ Special Rate: (attach explanation) FILE <br /> ❑ PERSONAL KNOWLEDGE <br /> ❑ OTHER: <br /> AUTHORIZED SIGNATURE: <br />