04102024-3A City of Anaheim
Office of the City Clerk
200 S. Anaheim Blvd., Suite 217
Anaheim, CA 92805
(714) 765-5166 a fax (714) 765-4105
www.anaheim.net
STEP 1: COMPLETE all fields on this form. This form is to factate and expedite the processing of your public records request.
Describe identifiable records in the possession of the City; your request must be sufficiently focused and specific to allow
the City to locate the requested record(s).
STEP 2: §UBMIT.courpleted form by mail, fax, email or in person to Custodian of Records, Office of the City Clerk, 200 S.
Anaheim Blvd. (714) 765-5166; ftass L�—Ianahei:mmet; fax (714) 7654105.
STEP 3: MWLAII to receive an invoice for responsive records. The City shall determine within I 0-days from receipt of a public
records request, whether the request, in whole or in part, seeks copies of discloseable public records in possession of the
City [GC Q53(c)]. Please note that if you are requesting the opportunity to inspect records, you will be requested to make
an appointment to return at a later date/time to view the documents.
Charges for the direct cost of duplication will apply. Documents wiHn.ot be copied until payment has been received. If
payment is not received within 10 days after invoice is sent, you may be required to submit a new request. Please see
backside for additional information.
REQUESTER INFORMATION
Full Name: I fy\'% V\ nn,0-0 Date: —10
Company Name: Lc,
(Mailing) Address: City/State/Zip Code: \JJ 5,1A c� '6� F\Z vs3ss
Phone number: Email:
Preferred method of contact in the event of questions:
documents reque" etc)
Sots
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Ck � S {5 C'
I understand that I will be contacted once documents have been identified. If production of records is requested, an
esti-u2tsf rw-tst will vt?%f 1 26wee 6,2t I V.0 le reAlii-ret t"16--mit 7ay-1 e-1t f+r du7licatila c%i'sts (a,-Cl-
mailing) prior to the production of the requeste4l documents.
'Ej I wish to inspect City records Will Pick -Up Records El"IF lease Mail
CA Public Records Act.
R-G—NATURE OF REQUESTER
(Government Code Section 6250 et seq.)
6, The Office of the City Clerk will provide an invoice for charges due. These charges are due and
payable upon receipt of the invoice. Uptca remittance of the invoice arnount, the records request -,V.d'l
be copied and sent to the requestor. If arrangernwets for payment and production are not made
within twentv (20) days of the date of the City's response, a new request may have to be submitted,
7. For further information, please refer to the California Public Records Act (California Government
Code �6250 et seq.) or contact the Of of the City Clerk, 200 S. -Anabeim Blvd, Suitc 217,
Anahc* CA 92805; Phone: (714) 765-5166.