01122024-7City of Anaheim
= Office of the City Clerk
> 200 S. Anaheim Blvd., Suite 217
Anaheim, CA 92805
(714)765-5166:-fax (714)755--4105
nnnKanahemi net
REQUEST FOR PUBLIC RECORDS
STEP 1: COMPLETE all fields on this form. This farm is to facilitate and ocliedite the prrocccesing of your public xee ards request.
Describe identifiab%raianls in the possession of tie City;. ymtr n quest muss. be sufficiently focused and specific to aiima�
the City to locate the requested m:t id(s).
STEP 2: SUBMIT completed form by mail, fax, count, or in person to Custodian, of Records, Office of the City Clerk,
200 S.:Anaheim Blvd:, State 217, Anaheim, CA 92805; tba. s'a anahomuet, fix (714).765-4105.... .
STEP 3: WAIT to receive a response from the City. The City shall determine within 10-days from receipt of a public records request,
whether the: request, in whole or in: part, seeks copies of discloscable public mcou3ss is possession: of the City (GC: 7927.535(a)].
Please note that if you arc requesting the oppornm4 to inspect records, you uafti bLrcquesbul to make an appointment to return at a
later date✓ mac, to view the documents
Charges for the direct cad ofiluplicatian rrill apply. Documents m M not be vapied until payment has been rvicelve L If payment is
not received d nidun 20 da -%after invoice is scat, yon may he: required to submit a new request. Please sex hocItsuk for additional
information:
REQUESTER INFORMATION
Full Name -y- } � zt 1
Compam'Name:
(Mailing) Address: City/State2ip Code:
Phone number. Email:
Preferred method of contact in the event of questions: � 6YI <2
DESCRIPTION OF REQUESTED RECORD(S): (Describe thespecific public record(s) e.g., date, t}pe,. time period covering
docmnetrtsrWuesteal, eet-cy)-�.
I W+� �s..CJ�'e-` 4.ot
C&ta�*% A hadtL; -n J5 W 4_c� A V
(� -rt-u<arL; ear- .e `L 3 o L+
I understand that I will be contacted once documents have been identified, If producfion of records is requested, an
estimated cost will be provided to me and I agree that I will be required to subntifpayment for duplication costs (and
mailing) prior to the production of the requested documents.
I wish to inspect City "records F]Will Pick -Up Records I Please Mail
Please note that infirrici ioncontained in any PRA request is a public record and may be subject to public inspection
pursuant to the California Public Records Act: ry
Ronrroct fur: Pohlir RornnAc SIGNATURE OF REQUESTER