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Exhibit 4 <br /> -AI"ENILLS <br /> CITY OF ARDEN HILLS <br /> INFORMATION DISCLOSURE REQUEST <br /> Minnesota Government Data Practices Act <br /> A. Completed by Requestor <br /> REQUESTOR NAME(Last, First, M.): DATE OF REQUEST: <br /> STREET ADDRESS: PHONE NUMBER: <br /> CITY,STATE.ZIP CODE: SIGNATURE: <br /> DESCRIPTION OF THE INFORMATION REQUESTED: <br /> B. Completed by Department <br /> DEPARTMENT NAME: HANDLED BY: <br /> INFORMATION CLASSIFIED AS: ACTION: <br /> ❑ PUBLIC ❑ NON-PUBLIC ❑APPROVED <br /> ❑ PRIVATE ❑ PROTECTED NON-PUBLIC ❑APPROVED IN PART(explain below) <br /> ❑ CONFIDENTIAL ❑ DENIED(explain below) <br /> REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br /> PHOTOCOPYING 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 /> 190435v1 <br /> 15 <br />