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REQUEST FOR EXAMINATION <br />OF PUBLIC RECORDS <br /> <br />DATE: <br /> <br />Under ORS Chapter 192, OAR 918-01-200 <br /> <br />SITE ADDRESS <br /> <br />I, HEREBY, REQUEST EXAMINATION OF FILES RELATING TO: <br /> <br />( ) ALL DOCUMENTS <br />( (SPECIFIC DOCUMENTS <br /> <br />NAME: <br /> <br />SIGNATURE: <br /> <br />ADDRESS: <br /> <br />PHONE#: <br /> <br />eo p.v. <br /> <br />FILE WILL BE AVAILABLE FOR EXAM~ATION FIVE (S) WORKING DAYS FROM DATE OF <br />THIS REQUEST, <br /> <br />Portions of this file have been exempted from disclosure ( )Yes ( ) No <br /> <br />A $20.00/hour mkdmum fee is assessed for clerical supervision of records when a request is made for 5 copies <br />or more, <br /> <br />Copies are $,20 per document. <br /> <br />hours at $20.00/hour -- <br /> <br />copies $.20 per document <br /> <br />TOTAL AMOUNT DUE <br /> <br />RECEIPT # RCVD BY <br />SIGNATURE: ~/~ <br />REV 5195 <br /> <br />DATE: <br /> <br /> <br />