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- PUBLIC RECORD RE <br /> LEASE REQUEST <br /> � . REQUEST RELEASE DATE <br /> 2 REQUESTING AGENCY <br /> 3. AGENCY ADDRESS PHONE NO. <br /> 4• INDIVIDUAL REQUESTING PHONE NO. g <br /> + 5• INDIVIDUAL ADDRESS <br /> FILE ADDRESS ITEM REQUESTED GATE PURPOSE OF REQUEST <br /> 4 V <br /> 1 <br /> i <br /> i <br /> *ASTERISK ITEMS REQUESTED POR PHOTOCOPYING <br />;16NATURE OF REQUESTING PARTY <br /> DATE <br />.00AL HEALTH DISTRICT LUSEONLY <br />'ROJECTED RELEASE DATE <br /> i <br /> SIGNATURE OF RELEASING OFFICIAL <br /> TAMES OF STAFF MEMBERS INVOLVED IN THE RELEASE AND MONITORING OF THE RECORDS 3 <br /> i <br /> 3 <br /> 1 00 14 <br />