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<br />e <br /> <br />e <br /> <br />e <br /> <br />Exhibit 3 CONSENT TO RELEASE <br /> <br />PRIVATE DATA <br /> <br />,I, <br /> <br />, authorize the City of Arden Hills ("City") to <br /> <br />(print name) <br /> <br />release the following private data about me: <br /> <br />to the following person or people: <br /> <br />The person or people receiving the private data may use it only for the following <br /> <br />purpose or purposes: <br /> <br />This authorization is dated <br /> <br />and expires on <br /> <br />The expiration cannot exceed one year from the date of the authorization, except in the case of authorizations given in <br />connection with applications for life insurance or noncancelable or guaranteed renewable health insurance and identified <br />as such, two years after the date of the policy. <br /> <br />I agree to give up and waive all claims that I might have against the City, its agents <br />and employees for releasing data pursuant to this request. <br /> <br />x <br /> <br />Signature <br /> <br />IDENTITY VERIFIED BY: <br /> <br />Witness: X <br /> <br />Identification: Driver's License, State tD, Passport, other: <br /> <br />Comparison with signature on file <br /> <br />Other: <br />Responsible Authority/Designee: <br /> <br />1 <br />