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190435v1 <br />13 <br />Deleted: 1¶ <br />¶ <br />Exhibit 3 <br /> <br /> <br /> <br /> <br />INFORMED CONSENT OF PRIVATE PERSONNEL DATA UNDER THE MINNESOTA <br />GOVERNMENT DATA PRACTICES ACT <br />I, __________________ authorize a representative of the City of Arden Hills, 1245 West Highway <br />96, Arden Hills, MN 55112 to obtain personnel data which is identified below. <br />The specific data covered by this release is personnel data. I understand that the personnel <br />data requested may include data which is classified as private personnel data on me under Minn <br />Stat. 13.43. I understand that by signing this informed consent form, I am authorizing the City of <br />Arden Hills to release this information. I ________________, understand that without my informed <br />consent, the City of Arden Hills could not release personnel data and records which are classified <br />as private under Minn. State 13.43. <br />I authorize my informed consent to permit the City of Arden Hills to make photocopies of the <br />requested data. <br />I place the following restrictions on the use to Arden Hills may make of this data while it is in their <br />custody and control: ____________________________________________________________. <br />This consent expires upon completion of the above stated purpose, or after one year, whichever <br />comes first. However, if the above described purpose is not fulfilled after one year. I may renew <br />this consent. <br />A photocopy of this releases shall have the same authority and meaning as the original. <br />I am giving this consent freely and voluntarily and I understand the consequences of my giving <br />this consent. <br /> <br />__________________________________________________ _______________________ <br /> Signature Date <br /> <br /> <br /> <br />Exhibit 3 continued <br />