REQUEST FOR DISCLOSURE OF DOCUMENTS UNDER THE OPEN RECORDS ACT

REQUEST FOR DISCLOSURE OF DOCUMENTS UNDER THE OPEN RECORDS ACT
Name of Requester*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone*
Fax
Email Address*
example@example.com
Date/Time of Incident

MonthDayYear
Date
Hour MinutesAM/PM Option
Citation #
Incident or Accident #
Event Type
Location
Officer
Pursuant to O.C.G.A. SS 50-18-70 et seq., I am formally requesting to inspect certain public records. In particular, records requested for inspection are:*
Date records are requested to be made available*

MonthDayYear
Date
There may be a fee incurred to the extent permitted by Georgia law. If a fee amount is determined, someone will notify you before completing the request. These costs are for search, retrieval, and other administrative tasks such as these charges do not exceed the salary of the lowest paid full-time employee who has the necessary skill and training to perform the request. The requester is not charged for the first fifteen minutes of time. I agree to pay any copying and/or administrative costs that may be incurred in fulfilling my requests to the extent permitted by Georgia law.
Name (Print)*
Signature*

Clear
RECORD RETRIEVAL FEES

Actual time of record preparation including research (varies) (less 15 min.)	Hrs x $	=$
Actual time of copying (varies)	Hrs x $	=$
$0.10 per page copy (8 1/2 x 11) $0.20 per page copy (11 x 17) $2.00 per page for building plan	___ Pages @ $0.10 ___ Pages @ $0.20 ___ Pages @ $2.00	=$ =$ =$
Postage		=$
Other costs:		=$
Video costs:	Copies @ $:	=$
Total actual costs:		=$