5704-5758 SW 40 ST_GREEN MISCA:WENT FOR PUBLIC RECORDS
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Address: .S o - S S w b S
Daytime Telephone Number. X 435-0
21OREQUEST TO VIEW TBE FOLLOWING.DOCUMEN'TS:
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❑ I. REQUEST COPIES OF T FOLLOWING DOCUMENT'S:
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STAFF TnAtfop, MONITOR _ hour(s) x $25.00/ hour =
STAFF MIE FOR RESEAR�M- _ hour(s) x $2S.00/ hour =
NUMBER OF 8 i4 x 11 inch PHOTOCOPIES x 15 cents/sheet =
NUMBER OF OTTER ORIGMALS (special order)
x PRICE PER rrEm •
SUB -TOTAL
TOTAL PRICE FOR TMS REQUEST FOR PUBLIC
RECORDS
Customer's Signature
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Today's Date
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