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cn�r oF ��rr <br /> PUBLIC DISCLOSURE REQUEST FOR INFORMATION <br /> Records Department Phone: (425) 247-8918 Fax: (425) 257-8882 <br /> 3200 Cedar St., Everett, WA 98201 <br /> Date: �ayf o� <br /> R��cors -/o� a,d uiend (sen^a,� <br /> PNnted Name: J '� and/or <br /> Business Name: �SeMa-Y��iopP,✓�rPS, LL � <br /> Signature: ��• I�« <br /> Address: I'.�.,Box � �95 e-mail: <br /> nn�kr�fQo 9sa�5 <br /> Pho�ie No. YaS� 3 30 93oZ S Note:If your phone has a b/odc on/t we <br /> cannot mnbct yrou. Please mntact us aRer <br /> Bve buslness days. <br /> Allow me to: —tnspect / �request a copy af the following records. <br /> Please be specific. I�YiLWi/'►g5, �.P�Ah- <br /> If record(s) concem individual(s) other than requestor, please state. <br /> Is/are the requested record(s) to be used for commercial purpose: _ Yes _. No <br />