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