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EXHIBIT 3 <br />INFORMATION DISCLOSURE REQUEST <br />Minnesota Government Data Practices Act <br />A. To be Completed by Requestor <br />REQUESTOR NAME (Last, First, MI): <br />DATE OF REQUEST: <br />STREET ADDRESS: <br />PHONE NUMBER: <br />CITY, STATE, ZIP CODE: <br />SIGNATURE: <br />DESCRIPTION OF THE INFORMATION REQUESTED: <br />B. To be Completed by the City <br />DEPARTMENT NAME: <br />HANDLED BY: <br />INFORMATION CLASSIFIED AS: <br />ACTION: <br />PUBLIC n NONPUBLIC <br />:n APPROVED <br />PRIVATE :n PROTECTED <br />n APPROVED IN PART (explain below) <br />NONPUBLIC <br />DENIED (explain below) <br />n CONFIDENTIAL <br />REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br />PHOTOCOPYING CHARGES: <br />IDENTITY VERIFIED FOR PRIVATE INFORMATION: <br />n NONE <br />n IDENTIFICATION: DRIVER'S LICENSE, STATE I.D., <br />Pages x = <br />etc. <br />COMPARISON WITH SIGNATURE ON FILE <br />Special Rate: (attach explanation) <br />PERSONAL KNOWLEDGE <br />n OTHER: <br />AUTHORIZED SIGNATURE: DATE: <br />:+Ii Exhibit 3 <br />4999?Q.z rvrn -MA 1125-D13J1& 0.v2 <br />