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C 11982 <br />CITY OF VERO BEACH <br />EXHIBIT C <br />REQUEST FOR REMOVAL AND/OR <br />ADDITION OF FACILITIES <br />City of Vero Beach <br />K <br />52Pr1 i�E <br />, 19 <br />Gentlemen: <br />In accordance with the terms and conditions of the Street Lighting Agreement <br />dated , 19 , this request is made for a removal <br />and/or addition of facilities in the existing Street Lighting System within the <br />limits of this body's jurisdiction. <br />The removal and/or addition requested is/are as follows (describe fully): <br />Approved as of the following Date <br />19 by: <br />CITY OF VERO BEACH <br />(Signature) <br />(City Manager) <br />(Signature) <br />(Title) <br />(Customer's Name) <br />