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EXHIBIT 3 <br /> REQUEST TO RELEASE PRIVATE DATA FROM AN INDIVIDUAL <br /> If you have a question about anything about this consent, or would like more explanation before <br /> you sign it, please contact the Responsible Authority (or Designee): <br /> City Clerk <br /> City of Arden Hills <br /> 1245 W Highway 96, Arden Hills MN 55112 <br /> 651-792-7811 <br /> I, , give my permission for the City of <br /> Arden Hills to release data about me to <br /> (name of other entity/person) as described in this consent. <br /> 1. The specific data I want the City of Arden Hills to release includes (explain data): <br /> 2. 1 understand that I have asked the City of Arden Hills to release the data. <br /> 3. 1 understand that although the data are classified as private at the City of Arden Hills, the <br /> classification/treatment of the data at (name of other <br /> entity/person) may not be the same and is dependent on laws or policies that apply to <br /> (name of other entity/person). <br /> [OPTIONAL] This permission to release expires (date) 20_at am/pm. <br /> Signature Date <br /> Signature of Parent/Legal Guardian Date <br /> 190435v1 <br /> 14 <br />