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<br /> <br /> Exhibit 3 <br />MU125\11\1101989.v1 <br /> <br />EXHIBIT 3 <br /> <br />INFORMATION DISCLOSURE REQUEST <br />Minnesota Government Data Practices Act <br /> <br />A. To be Completed by Requestor <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 /> <br /> <br /> <br /> <br />B. To be Completed by the City <br />DEPARTMENT NAME: HANDLED BY: <br />INFORMATION CLASSIFIED AS: <br /> <br /> PUBLIC NONPUBLIC <br /> <br /> PRIVATE PROTECTED NONPUBLIC <br /> <br /> CONFIDENTIAL <br />ACTION: <br /> <br /> APPROVED <br /> <br /> APPROVED IN PART (explain below) <br /> <br /> DENIED (explain below) <br />REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br />PHOCOPYING CHARGES: <br /> <br /> NONE <br /> <br /> ______ Pages x ______________= ____________ <br /> <br /> Special Rate: ______________ (attach explanation) <br />IDENTITY VERIFIED FOR PRIVATE INFORMATION: <br /> <br /> IDENTIFICATION: DRIVER’S LICENSE, STATE I.D., etc. <br /> <br /> COMPARISON WITH SIGNATURE ON FILE <br /> <br /> PERSONAL KNOWLEDGE <br /> <br /> OTHER: ________________________________________ <br /> <br />AUTHORIZED SIGNATURE: DATE: <br />