REQUEST FOR RECORDS

REQUESTOR NAME:

First Name    Last Name

Street Address

City      State    Zipcode

Daytime Phone   -      Fax   -

Email Address

Description of record(s) sought

Department Requested From

I would like to view/inspect the record(s)
I would like to receive copies of the record. I understand that the City charges a fee for copies of records and the copies will be provided subject to fees being paid.
I authorize costs of up to $ .
If costs are greater than the amount I have specified, I further understand that the office will contact me and will not respond to a request for copies if I have not authorized adequate costs.

PRINT NAME       DATE May 28, 2023