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Stockton <br /> t iF <br /> CITY OF STOCKTON <br /> CITY OF <br /> -==? INFORMATION / COPIES / RESEARCH REQUEST <br /> 4 STOCKTON Notice: Requests for information may be subject to approval by the City Attorney <br /> NAME: C_;cir,� �� S DATE: o <br /> ORGANIZATION: �a.� -,,L,; , T �� If TELEPHONE: `T Ej�^ <br /> lac.-.,l-FL•. t��p�--' �`- � CS�7 <br /> ADDRESS:_ --304- L tk �c'-�jcr A ,,, <br /> o —r <br /> I, the undersigned, agree to pay for research and all copies made at my request at the rate listed f& at ice rn <br /> in the City of Stockton Fee Schedule at the time of my request. <br /> II U <br /> SIGNATURE <br /> AFFECTED ADDRESS (IF ANY): <br /> INFORMATION REQUESTED (PLEASE BE SPECIFIC): <br /> r A' :iw-�•n <br /> REASON FOR REQUEST: <br /> FOR THE USE OF CITY ATTORNEY'S OFFICE ONLY �- <br /> REQUEST FOR RELEASE OF INFORMATION IS: APPROVED DENIED l <br /> D TE SIGNATURE OF CITY ATTORNEY OR AUTHORIZED REPRESENTATIVE <br /> COMMENTS: <br /> FOR CITY USE ONLY ° <br /> RECEIVED BY: Mr- DATE RECEIVED: � <br /> RETURN THIS REQUEST FORM TOIJ F' i��� j,{�. (( I'LL{ IL US �C � r. � S <br /> NAME DEPARTMENT PHONE <br /> RESPONSE TO REQUEST: <br /> SERVICE FEE x QUANTITY = CHARGES FEES DUE: YES NO <br /> Copies First page $1.00 <br /> Additional pages $0.25 per page <br /> Documents Notes: <br /> Certifications <br /> Media <br /> Research Time $8.10 per 15 min. <br /> (minimum 15 min.) TOTAL DUE _ $ <br /> COMPLETED BY: DATE: ' I <br /> ddimas 6/22/05 <br />