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EXHIBIT 3 <br />INFORMATION DISCLOSURE REQUEST <br />Minnesota Government Data Practices Act <br />To he Comnleted by Reauestor <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 />To he Comnleted by the Citv <br />DEPARTMENT NAME: <br />HANDLED BY: <br />INFORMATION CLASSIFIED AS: <br />ACTION: <br />❑ PUBLIC ❑ NONPUBLIC <br />❑ APPROVED <br />❑ PRIVATE ❑ PROTECTED NONPUBLIC <br />❑ APPROVED IN PART (explain below) <br />❑ CONFIDENTIAL <br />❑ DENIED (explain below) <br />REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br />PHOCOPYING CHARGES: <br />IDENTITY VERIFIED FOR PRIVATE INFORMATION: <br />❑ NONE <br />❑ IDENTIFICATION: DRIVER'S LICENSE, STATE I.D., etc. <br />❑ Pages x = <br />❑ COMPARISON WITH SIGNATURE ON FILE <br />❑ Special Rate: (attach explanation) <br />❑ PERSONAL KNOWLEDGE <br />❑ OTHER: <br />AUTHORIZED SIGNATURE: DATE: <br />Exhibit 3 <br />MU125\1 1\1 101989.v I <br />