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<br />Exhibit 4 <br /> <br />CITY OF ARDEN HILLS <br />INFORMATION DISCLOSURE <br />REQUEST Minnesota <br />Government Data Practices Act <br /> <br />A. Completed by Requester <br /> <br />REQUESTER NAME (Last, First. M.): <br /> <br />DATE OF REQUEST: <br /> <br />STREET ADDRESS: <br /> <br />PHONE NUMBER: <br /> <br />CITY. STATE. ZIP CODE: <br /> <br />SIGNATURE: <br /> <br />DESCRIPTION OF THE INFORMATION REQUESTED: <br /> <br />B. Completed by Department <br /> <br />Department Name: <br /> <br />Handled By: <br /> <br />Infonnation Classified as: <br />Public _ Non-Public ~ Private <br />Protected Non-Public Confidential <br /> <br />Action: <br />_ Approved <br />_ Approved in Part (Explain: <br />_ Denied (Explain: <br /> <br />PHOTOCOPYING CHARGES: <br /> <br />IDENTITY VERIFIED FOR PRIVATE INFORMATION: <br /> <br />_ None <br />~ Pages x <br /> <br />~$ <br /> <br />Driver's license <br />== File Signature <br />Other: <br /> <br />State Identification <br />~ Personal Knowledge <br /> <br />Dated: <br /> <br />Authorized Signature: <br /> <br />13 <br /> <br />. <br /> <br />) <br />) <br /> <br />. <br />