04232024-3Elm
City of Anaheim
F° * Office of the City Clerk
200 S. Anaheim Blvd., Suite 217
Anaheim, CA 92805
VNAED 4^ 714) 765-5166 a fax 714) 765-4105
www.anaheim.net
STEP 1: COMPLETE all fields on this form. This form is to facilitate 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: SUBAW.completed form by mail, fax, email or in person to Custodian of Records, Office of the City Clerk, 200 S.
Anaheim Blvd. (714) 765-5166; tbass(cd naheiramet; fax (714) 765-4105.
STEP 3: WAIT to receive an invoice for responsive records. 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 discloseable public records in possession of the
City [GC 6253(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 will not 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 : e, -i tM e.,) t,)leltiRtiNl i C IJ Date:
Company Name:
Mailing) Address: City/State/Zip Code: iNb2 11. CA
Phone number: Email:
Preferred method of contact in the event of questions:
DESCRIPTION OF REQUESTED RECORD(S): (Describe the specific public record(s) e.g., date, type, time period covering
documents requested etc)
jam t}F C of TCS p. Ol)l L INET O 3 1 C1 t t'N
20 z 2
I understand that I will be contacted once documents have been identified. If production of records is requested, an
estimated cost will be provided to me and I agree that I will be required to submit payment for duplication costs (and
mailing) prior to the production of the requested documents.
I wish to inspect City records [] Will Pick -Up Rec s Please Mail
Please note that information contained in any PRA request is public rec rd and may a subject to public inspection pursuant to the
CA Public Records Act.
SXNA:TURE OF REQUESTER