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! <br /> � <br /> I , <br /> REQUCST FOR RECORDS � � <br /> CITY CLER&'S OFFICE � <br /> , EVERETT, l�ASHIHGTOi7 � �. <br /> Print � Q �J'� \ / � <br /> Na�e �� ,�i GC s. C a r S o �J Signatur�r} c �• —C s� � <br /> i ' <br /> Addresss�--�t �o t✓c �- �--..✓ �t ? <br /> Telephone ' <br /> � v�-�+-i` F � � �S t.o ( Number � S �� C 2 G / � � <br /> � :�� <br /> � Records � .. �� � � ' <br /> Requested �-�- c o��� s Y�'��w�� � � ` ��`� <br /> . ` � <br /> � � , '' <br /> '• llbv �� �. �, ��. � - <br /> n� <br /> . . � �� <br /> . ,i <br /> + Request ' � , <br /> �, <br /> Recvd. by Date Time t <br /> • Signature k � � <br /> i '�� <br /> � <br /> * * Request Received .,_, <br /> • forwarded to SY b� <br /> Department y�r <br /> � <br /> *• Response Due Date M,",� <br /> i t§� <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 issuance to requestor. (Ord. 313-74) <br /> ACTION TAY.EN ON RECORD <br /> REQUEST <br /> Delivered Date No. Pages Certified <br /> Exempt _ Time_ No. Copies _ <br /> Attachments <br /> Em�loyees Sign. <br />