6400 SW 62 ST_GREEN MISC -- CITYOFSOUTHMDM
F SOUTH
- ---_- - - --_REQUEST FOR PUBLIC_RECORDS ._ .
For reference and record purposes,may we have the following:
Name:
Address:
Daytime Telephone Number:
I REQUEST TO VIEW THE FOLLOWING DOCUMENTS:
REQUEST COPIES OF THE FOLLOWING DOCUMENTS:
tj Co Z
— P� a (MA 04-
STAFF TIME TO MONITOR: hour(s) x $25.00/ hour=
STAFF TIME FOR RESEARCH: hour(s) x $25.00/ hour=
NUMBER OF 8 V2 x 11 inch PHOTOCOPIES x 15 cents/sheet =
NUMBER OF OTHER ORIGINALS (special order)
x PRICE PER ITEM
SUB-TOTAL
TOTAL COST FOR THIS REQUEST FOR PUBLIC RECORDS
Customer's ignature oday's Date