Information Request Form

Date*

Date

Name:*

First NameLast Name

Title:*

Company Name (if applicable):*

If not applicable, enter N/A.

Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone:*

Area CodePhone Number

Email*

example@example.com

This request is for: (check one)*

InspectionCopying

This request is for: (check one)*

BusinessPersonal

Please list, as clearly as possible, the name and/or type of document and the date range of the document(s) requested:*

* Where there is a request made for inspection of an open public record, no fee shall be charged A fee of .25 per page shall be charged for photocopying an open public record for documents having the dimensions of 8.5 x 14 inches or smaller or a maximum of $1.00 per page for a certified copy For copying any open public record that cannot be reproduced by photocopying such as a blueprint, the requester shall be charged the actual cost to the City including the cost of labor, materials, and equipment A search fee shall be charged a requester who is using the record solely for a commercial purpose of where the request would clearly cause excessive disruption of the public body's essential functions. Such fee shall be the actual cost to the city of producing the record, including the cost of labor, materials, and equipment A record custodian may demand prepayment of a fee whenever the estimated amount exceeds $20.00. The prepayment amount shall be an estimate of the cost of copying, mechanical reproduction or searching for the record Any overage or underage in the prepayment amount shall be settled prior to producing the requested record or delivering the copy of mechanical reproduction of the record

Signature