SUB-05-0456 Rqst For Public Records 021508 001~. ; ~ _
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CITY OF YELM
REQUEST FOR ACCESS TO PUBLIC RECORDS
The following information is to be filled uut by the person requcsfing records: J
Dote of Request ~ ~~~~~ ~ ~~Pe~(~PY ~~~~"~~ /`~~L'~l//6,5~ lGrry/
Name of Person Making Request: SCI VI> ~PE'~~Py
G )~' ~~
Address: ~~~~ i ~ S ~ ~ ~ L'
City: cigq Wa State: Wq. Zip: U~~~ Phone: ~%''~~-~9 g~Sl ~~
lJ (his is nn enrcrgency revues ~, indicate the dote dented and pleose devcrihe the nature u~lhe
emergrnav:
RECORDS REQUESTED: (Please state the title and date of the record(s) being
requested): y
Pleaxc dcs-cnhe any additional information that will help us locate the records as quickly as
pwslble:
Requestor's Signature: ~ _ _ Uatc: ~ ~~ d
For City Use Only
StaCi person receiving request _, Da[c _. __
Number of Copies: .,__ Total Charge:
Sniff pervon who provided records: _ _ _
Uate: Client name receiving records'.
ds-wordifornts/pubhcrecordsaqucstform_doc
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