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i <br /> ► <br /> �..� . � � <br /> : � <br /> ; <br /> REQUGST FOR RECORDS I <br /> CITY CLERK'S OFFICE ' I <br /> , EVERETT, 1JASHIL7GTOti I <br /> Print I' C(a�,� �� �XS�1. <br /> Na�e (\'{�L`a Signature �4'�� <br /> Address (� � � ' Wl�'�• <br /> Telephone �-, ,1 <br /> � �j� 1,.�l� `3�6Z15 • Number �tf� - (?� G. <br /> Records <br /> Requested 5 ��1+ �� +�. Io v ��'t ���. S ' _ <br /> Request � 1`� �"" � ( � . <br /> Recvd. by Date ��"�� � � Time � � �_ � <br /> • Signature <br /> - - - - - - - - - - - - - - - - - - - - - <br /> * * Request Received <br /> " • forwarded to BY <br /> Department <br /> ** Response Due Date ' <br /> ** Department receiving the request should attach information requested <br /> or a statement as to why the record is not being dispensed and <br /> return to the City Clerk for i.ssuance to requestor. (Ord. 313-74) I <br /> � <br /> ACTION TAY.EN ON RECORD I <br /> RGQUGST <br /> I <br /> Delivered Date No. Pages Certified � <br /> Exempt Time No. Copies j <br /> Attachments <br /> Em�loyees Sign. <br /> �I <br /> I <br /> i <br />