Page Two                      

#1 - Complete the top two lines with your name, phone number, and
        address.

 #2 - Name: The City and County of San Francisco
                     1 Dr. Carlton Goodlet Place, Room 200
                      SF CA 94102

         It's a public entity: Name: Diane Rea, County Clerk
                      1 Dr. Carlton Goodlet Place, Room 200                     
                       SF CA 94102
   
#3 -  Enter a monetary amount (up to $10,000) that you feel the City                    and County of San Francisco owes you for compensation.
        
#3 a - Enter why you feel the CCSF owes you money.

                                                 Page Three

#3 b - On "date started", the small claims department requires an
           approximate month and year when you were first aware of the noise.

          On "Through", enter a single date when you stopped being affected
          or enter today's date.          
 
#3 c - Enter specific expenditures if you had/have to replace
           your windows, et al. If you haven't incurred costs, enter what
           comes to mind that you've had to endure, such as the loss of
           tranquility, sleep, concentration, the smell of fuel, et al.
                                      
#4 - Check "yes".

#5 - Check "5c" - I personally enter "The cities that are in the SFO's
        runway noise corridor are in San Mateo County."

#6 - Enter your zip code.

#7 - Check "No".

#8 - Check "Yes". Where it says "A claim was filed on (date)", look at 
        the letter from San Francisco. Its first  sentence has your
        claim date.

                                   Page Four

#9 - You'll probably check "No".

#10 - Check "yes" or "no".

#11 - Enter the date. Type or print your name.

         After the arrow, sign your name.
                                                                   
     PRINTOUTS: AFTER FILLING OUT THE 3 PAGES, PRINT OUT 3
                        ADDITIONAL COPIES OF PAGES 2, 3, AND 4. 

                                                                                                                                                                                                                                                                                                                     sallymeakin@yahoo.com