2. Company
4. Name*
6. Phone Number*
8. Address*
10. City*
12. State*
14. Zip Code*
16. Fax Number
18. Email:
20. Date*
22. Record Sought: Please provide a specific description of the record(s) you desire to inspect. Include record titles and dates, as well as the name of city agencies or departments which produced or hold the record(s).*
24. Time:
    If the amount of time necessary to process the Request for Records is less than 30 minutes, you should receive the information within four business days and will be charged for copy costs. If the request for records will take in excess of 4 hours to process, you will be notified of the earliest practicable date the information will be available and will be given a cost estimate.
26. Charges:
    Copy charges are set at a level to compensate the city for costs incurred in honoring your request. An administrative fee of $15.00/half hour will be charged for any request requiring staff time in excess of 4 hours. A fee schedule for regularly requested items is posted in the City Clerk's office. Depending on the cost of the records requested there may be a deposit required.
28. Office Use Only:

    Time Access Provided: Date__________ Time ________

    Staff Time Involved: ______ Hours ______ Minutes

    Charges: $_______________

    Paid: $_______________ Date: _______________

    GL Account Number: _______________

    _______________________________
    Signature of Record Custodian
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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