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� <br /> r '� <br /> , ., <br /> � <br /> � � ar4ursT roi: iar;c����us <br /> cz7�v ct,r•.ar� s orriri; <br /> i <br /> Lvei�i:�rr, �:nsuruc.oii <br /> ; (��� <br /> i� � � � r <br /> Frint " � P ('a f}VI L ! - <br /> Name � � �S Siynatum <br /> Address �L�P ��C�'� �CXLA�ILL 1/rL ��AL`YEfT <br /> T Nunbe�lrone �S c��3�� <br /> z82sr .,�YI� <br /> �V��` , r�. 98"zoi <br /> Records �^ nL� ��� J 5/�! �KS P�c�TGrL �S� �lLl� <br /> Requested 41�1�.���5 h�''- �`^' � ' � , / <br /> ', l Z �IZ E . C�4 S11lLt� �. V�L�c?T�_.�/I� . , (�l1GL�JN�� <br /> _ �,r,p � lU✓ T(C low �.PnJU��Jl� <br /> IuSEf.uror[ f��e�u �r�E� � 1� 2 cL �isr � .D�f, - <br /> S � l�w�ct� � PoSTr �lG � U/�p!K �JTt• Xan G� �� <br /> Re uest C��`�'u�`" '' ` 4 ��,��, � ��/p <br /> Recvd. by � Date .�- / 5-j'J' 7'ime j/� : =� / ! <br /> � Sig ature /�Z <br /> - - - - - - - - G����� �,� <br /> � D* * Received���/ �f f? 1 r , <br /> Reque�t D kl'f /��,.,_� •� •�q; <br /> forwarded to � �De�ment f �/ --��y �F <br /> �' �nspe�tiop��FTT <br /> ** Response Due Date -=? - /7� J� <br /> ** Department receiving the recluest should attach inforr�ntion rec(uesCed <br /> or a statement as to why the record i.s not hein9 ciis��en:;crl and <br /> return to the City Clerk for issuance to requestor. (��rd • 313-74 ) <br /> ACPION 'I'AI:PN ON ItIfC��ItI� <br /> RliQUiiST <br /> No. Pa9es Ccr+_i ( i ���l — <br /> Delivered_ Date No. Co ies <br /> Exempt � Time P _-- <br /> .. <br /> Attachments_ - --- ; ,,; I ,;, ,,,�., ;Si�jn. <br /> J <br />