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REQUEST TO ACCESS A GOVERNMENT RECORD DATE: 0- / 1 47 0 Department of Finance Division: ` 0 / Y P TO: County Y D �' FROM: C` '4401 ' ' t�Z1 i�� t.e� (41/4 1 Name or Alias Contact Information JJ q Ot �ttc r = ' , - �fI ._ ■ /�1 l I (/ Izo A . /J,- `6, Although you are not required to provi,'e any personal information, you should provide enough information tc allow the Department to contact you about this request. The processing of this request may be stopped if the Department is unable to contact you. Therefore, please provide any information that will allow the Departme, to contact you (name or alias, telephone or fax number, nailing address, e -mail address, etc.). I WOULD LIKE THE FOLLOWING GOVERNMENT RECORD: Describe the government record as specifically as possible so that it can be located. Try to provide a record name, subject matter, date, location, purpose, or names of persons to whom the record refers, or other information that could help the agency identify the record. A complete and accurate description of the government record you request will prevent delays in locating the record. Attach a second age if need • d. . Ctli ak aiidur 4 .00 c_ l',. i__ ori a_./ 3 1 i a_ 't e' iii ' 1 - 1 / . ' - 1 - A T h i w- toed 1, : 7iniiinte giiiiirid (t c at t v--e_s Air - ZD i 0 , I WOULD LIKE: (Please check one or more of the options below.) I ITo inspect the government record. i ' A copy of the government record. (Please check one of the opt ,! • ' , i) k_ ' ; `, information about fees that you may be required to pay for agenc , Copying and transmission charges may also apply to certain opts ti ,.( I II will pick up the record on (date and tune): lease mail the record to me at the above address. 1 - lill / I 7please fax me the information (toll free only): Fax t 1 'Other, if available (please specify): ' . j - I The government record in the following format (if it is mainta ' I (Electronic I 'Audio Other (please specify): • I IA fee waiver because this request is in the public interest (see waiver information on back). For Finance Department Use only. Date received: ' 'Required 1 (initiated by Requester I 'Disagreement over denial I I Fees over $15 I 'Other OVER Pnrr,. I nr Z - -