GRAMA

Records Request Form
**IF YOU ARE REQUESTING A POLICE DOCUMENT EXIT THIS FORM AND FILL OUT THE POLICE REPORT REQUEST (GRAMA)**

This is located on the city website under transparency tab
Requestor Information
Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Date*

MonthDayYear
Date
Time
Requested Record Status (check all that apply)*

The requested record is a public record.I am the subject of the requested record.I am the parent or legal guardian of the subject of the requested record.I am the provider of the information in the requested record.I have a “power of attorney” or notarized release from the subject of the record, or from the provider of the information in the requested record.I have a legislative subpoena or court order requesting the record.
Description of Requested Record (use additional sheets if necessary)*
Agreement:
In requesting this record, I understand and agree to the following:

I will pay cost associated with the provision of the records following UCA 63-2-203:

Copies
- 25 cents per page
- Certified copies $5.00 per page
Staff time required to search, compile and otherwise prepare to provide a record:
- Actual cost, not to exceed salary of lowest paid employee who, in the discretion of the record’s custodian, has the necessary skill and training to perform the request. Staff time for photocopying, faxing and making CDs and DVDs is included in the fee for those items.
Other Services (e.g., fees for third party services)
- Actual cost
I will allow a maximum of ten (10) working days for Lindon City to compile the record, or five (5) days if I show that such expedition will benefit the public more than my person. I will recognize that this completed Records Request Form is a public document.
Signature

Clear
Date*

MonthDayYear
Date
Should be Empty:

Records Request Form

**IF YOU ARE REQUESTING A POLICE DOCUMENT EXIT THIS FORM AND FILL OUT THE POLICE REPORT REQUEST (GRAMA)**

Requestor Information

Agreement:

IF YOU ARE REQUESTING A POLICE DOCUMENT EXIT THIS FORM AND FILL OUT THE POLICE REPORT REQUEST (GRAMA)