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Prinf: <br />Nafie <br />Address <br />RGQUGST FOR RECORDS <br />CITY CLERK'S OFFICE <br />EVERGTT, IJASHZP]GTOt7 <br />, <br />� r -� <br />1gRaCU�(e .� �G/F n�� � ��� ,� �� r.= ( _r:� <br />� <br />-�,����'��,r� ��, �� � <br />Records <br />Requested <br />Telephone � <br />Number ,�� — ,�� % � _ <br />Request � ! ' `"- `� � � / r� C, <br />Recvd. b Date 1�i Time <br />• Signature - � <br />:. <br />Request <br />forwarded to <br />Response Due Date <br />epartment <br />Received <br />Hy <br />** Department receiving the request shoul.d attach inforr�ation 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 />Delivered Date <br />Exempt _ Time <br />Attachments <br />11CTION TAY.EN Ot7 RECORD <br />aepuesT <br />No. Pa9es Certified <br />No. Copies-� <br />�� da <br />Employees Sign. <br />