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<br />Exhibit 4 <br /> <br />e <br /> <br />CITY OF ARDEN HILLS <br />INFORMATION DISCLOSURE REQUEST <br />Minnesota Government Data Practices Act <br /> <br />A. Completed by Requester <br /> <br />REQUESTER 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 /> <br />B. Completed by Department <br /> <br />DEPARTMENT NAME: <br />INFORMATION CLASSIFIED AS: <br />n PUBLIC 0 NON-PUBLIC D PRIVATE <br />PROTECTED NON-PUBLIC <br /> <br />a CONFIDENTIAL <br /> <br />n <br /> <br />HANDLED BY: <br />ACTION: <br />a APPROVED <br />D APPROVED IN PART (Explain <br />below) <br />D DENIED (Explain below) <br /> <br />REMARKS OR BASIS FOR DENIAL INCLUDING STATUTE SECTION: <br />PHOTOCOPYING CHARGES: <br /> <br />D NONE <br />o ~ Pages x _0 = a SpecIal <br /> <br />IDENTITY VERIFIED FOR PRIVATE INFORMATION: <br />D IDENTIFICATION: DRIVER'S LICENSE, STATE ID, Etc. a <br />COMPARISON WITH SIGNATURE ON FILE D PERSONAL <br />KNOWLEDGE D OTHER: <br /> <br />Rate: <br /> <br />(attach explanation) <br /> <br />AUTHORIZED SIGNATURE: <br /> <br />. <br /> <br />2 <br />