PUBLIC RECORDS REQUEST FORM

PUBLIC RECORDS REQUEST FORM

Please note that this form is not confidential and may itself be subject to public disclosure pursuant to Iowa Code Chapter 22.
Status

CompletedDeniedDuplicate Request
Employee/Date Completed
REQUESTER INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Email OR phone number is required in case we need to reach you with questions about your request.
GENERAL INFORMATION
Department*
Record Request Details*
Please provide a clear description of the public records you are requesting. Include dates, subjects, and specific details to assist in locating records.
Preferred Method of Response:*
Fee and Cost Information:*
Reason for Fee Waiver Request:*
ACKNOWLEDGEMENT
I understand that this request is subject to the Iowa Open Records Law, and the City of Fort Dodge will respond within the timeframe allowed by Iowa Code Chapter 22 (typically within 10–20 business days). If access is denied in whole or part, I will be provided the reason and informed of my right to appeal.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: