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Y OF R klE"�T <br />PU$L1C ONCLO tIt RlQtT MR IN FORMATION <br />Phones NEST EST4 010 AM Wetwori Are. <br />$.15 per pnge_(or costs of copying (Title 42 R. . W. ) <br />Requestor's s — Requestor' <br />Printed Name: % Signature: <br />Address: C7• CGS Phone No.: 3rw-L�gUp <br />Business Name — — <br />me to: inspect _ request a cope of the following 'curds: <br />If record(s) concern individual(s) other ...an reyuestor. Please state. <br />Is/are the requested record(s) to he used tier it commercial purpose'! _Yes YNo <br />Request was made:In person _ By phone _ Fax _ Mail <br />Date request received: By (Dept.): Response Due date: _ <br />Allow access. The applicable department has been notified. and <br />you may access the requested records. <br />Deny access. The City has determined that the records you have <br />requested are exempt under the law for the <br />following reasons: <br />We do not have the record(s). Explanation: <br />Date Requestor notified: _ By Mail By Phone In person <br />I certify that notification of final City response was carried out by me as stated above. <br />Signature of Notifying Employee: <br />No. of copies Certified _ Treas. Receipt q <br />Copy 1 - Clerk's Once Copy 2 - Appropriate Dept. <br />GL-00:: 341 61 00000 <br />Copy 3 - Requestor <br />