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� � <br /> REQUSST FOR RECORDS <br /> CITY CLER!('S OFFICE � <br /> EVERETT, S�ASHIlIGTOt7 <br /> Print n �/ _f� '��l�--- <br /> Na�e ���`/p.��Z.r��� Siqnature � <br /> , Address 6�? �� Z ��� . <br /> � Telephone ^�/ <br /> �,�y�.Lr- '�,�/ Number <br /> Requested � � ���� ��17�/ ' " 'fl�/Oz/�/ /�� <br /> • � O' 19 s 9 �iw�� • <br /> S • <br /> 4 <br /> � . . <br /> � Request / � . <br /> � Recvd. by Date �/yl�o Time 3.� 5�� <br /> r . gnature • <br /> � — — — — — — — — — — — — — — — — — -- — — — <br /> {, <br /> + *• Request � Received ��_4p <br /> ' • forwardad to $Y. • <br /> � De artment <br /> ; <br /> � <br /> � +�* Response Due Date . <br /> t • <br /> } ** Department receivinq the request should attach inforiaation requested <br /> ror a statement as to why the record is not being dispensed and <br /> ; return to the City Clerk for issuance to requestor. (Ord• 313-74) <br /> t • <br /> , <br /> � ' �� � � <br /> � ACTION TAKEN ON RECORD <br /> REQUEST <br /> Delivered ✓ Date J' zz o No. Pages ! Certified <br /> � Exempt Time ,7.�y.2 No. Copies i _ <br /> � Attachments Em loyees S�gn. <br /> R <br /> t <br />