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the municipal secretary desktop reference manual - Southwestern ...

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RECORD REQUEST<br />

DATE ________________________________________________________________________<br />

NAME _______________________________________________________________________<br />

ADDRESS ____________________________________________________________________<br />

_____________________________________________________________________________<br />

PHONE NUMBER _____________________________________________________________<br />

DESCRIPTION OF RECORDS (For more space, continue on back)<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

______________________________________________________________________________<br />

INSTRUCTIONS: PICK-UP FAX MAIL DISK<br />

SIGNATURE (When request is fulfilled)<br />

______________________________________________________________________________<br />

For Office Use Only:<br />

Copies ______ Postage _______ Disk _______ Fax _______<br />

TOTAL COST _________________<br />

DATE REQUEST FULFILLED _______________________<br />

INITIALS OF STAFF MEMBER ____________________________<br />

DATE INFORMATION: Picked up ___________ Faxed ___________ Mailed ___________<br />

XV-75<br />

Revised May 2006

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