7114 Crystal Springs St 100803966[ - 660 -09E -
i
.+
f
' f
966[ - 660 -09E -
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.+
J60-458-
1996
tCA1,4N- U
RECEIVED
FEB - 4 1003
Par
9 CITY OF YELM ocrtcuuwsoatr
PO BOX 479 Dab Rw l ed
WA 98597
(360) ar
(360) 456 -3244
\F LM J
CITIZEN ACTION REQUEST
NOTE: Information provided on this request form Is subject to public disclosure,
and Is available to Individuals upon request. H you wish to remain anonymous,
the City of Yelm reserves the right to not follow -up on the request.
NAME:
PHONE:
Home Business
ADDRESS:
MAILING ADDRESS (if different then above):
DATE: TIME:
SITUATION DES RIPTION: C- P-�-
V
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b
For City of Yelm Official Use Only'
Routed tj1h.14 On:
Response /Information Given:
Suggested Action to be Taken: I Y
l7fi . wrY not w t/� I nP�� i dti1 iG
S KA,(l,jfil ce
y� a/� o my"'n2
Complaint and suggested action to
Action assigned to:
Action to be initiated by
Action taken if other than above:
n
Dept. Head 9,115 /03
Satisfactorily resolved /Completed on:
By:
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