Falmouth, KY: Open Records Request Form

Request to Inspect Public Records

Pursuant to the Kentucky Open Records Act (“the Act”), KRS 61.870 et seq., the undersigned requests to inspect the public records which are described below.

Requester’s contact information

Name:*

First NameLast Name

Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail address:

Phone Number:*

Records to be inspected:*

Statement regarding the use of public records. KRS 61.870(4) defines “commercial purpose” as “the direct or indirect use of any part of a public record or records, in any form, for sale, resale, solicitation, rent, or lease of a service, or any use by which the user expects a profit either through commission, salary, or fee.” However, “commercial purpose” does not include the publication or related use of the public record by a newspaper or periodical, by a radio or television station in its news or informational program, or by use in the prosecution or defense of litigation by the parties to such an action or their attorney.

Request is for:*

NOT for a commercial purposeFOR a commercial purpose

Statement regarding residency. I further state that I am a resident of Kentucky because I am :*

An individual residing in the Commonwealth; orA domesticbusiness entity with a locationin the Commonwealth; orA foreign business entityregistered with the Kentucky Secretary of State; orAn individual that is employedand works at a locationwithin the Commonwealth; orAn individual or business entitythat owns real property withinthe Commonwealth;Anindividual or business entity that has been authorized to act on behalf of an individual or business entity listed above; orA news-organization as defined in KRS 189.638(8)(b)1a. to e.

How you would like to receive your copies after payment has been processed:

Postal MailEmailFaxReview Records ONLY

A PERSON WHO VIOLATES KRS 61.874 (INDICATING RECORDS REQUESTED FOR
COMMERCIAL OR NONCOMMERCIAL PURPOSE) SHALL BE LIABLE TO THE CITY
FOR DAMAGES, COSTS, AND PENALTIES TO THE AMOUNT ESTABLISHED BY LAW

I hereby certify the information provided in this request is true and accurate.

Signature*

Date

Enter the message as it's shown*

Pursuant to KRS 61.876(4), the Office of Attorney General has promulgated by administrative regulation this form. See 40 KAR 1:040.