City of Boston Mold Meeting Order Form for 12/9/04 Environment Committee hearing

[Guest guest]

Boston City Council Meeting/Hearing Copy Request Form

Submitted to:

Program Manager

Boston City Council

Boston City Hall, 5th Floor

Boston, MA 02201

(617) 635-2208

Date Submitted: ______________________

COST: $15.00/hearing or meeting requested.

Contact Name:

Organization:

Address1:

Address2:

City:

State:

Zip Code:

Contact phone:

Contact email:

Please complete the following information, so that we may process your

request:

Council Meeting

Date:

see below

Number of Copies Requested: ___________

Cost Per Copy: $15.00

TOTAL DUE: ____________

Payment Method: Cash

Check “City of Bostonâ€

Delivery: Pick Up Mail

Date Paid: ___________________________

Received by: _________________________

Committee Hearing

Committee:

Environment

Date:

12/9/04

Docket Number:

Subject:

Mold Contamination

Please Note: All payments for copy requests are to be submitted BEFORE any

copying will be done. The Boston City Council cannot guarantee that a copy

will be completed at a specific date and time. All efforts will be made to

complete your request in a timely manner. You will be notified when your

copies

are completed. Only full copies will be produced, not editing will be done.

FOR COUNCIL USE ONLY:

Request Received by: In Person

Telephone Email Web

Received by (initials): _________________

Date Received: _______________________

Date Completed: _____________________

Completed by: _______________________