2. 
4. Name of Requestor:*
5. Date:
   Date:
7. Phone Number:*
8. Fax Number:
10. Mailing Address*
12. City*
13. State*
14. Zip*
16. Email Address*
18. Preferred Manner of Written Communication*
    -- Select One --E-mailStandard Mail

    Please Note: If the information requested is unclear or if a large amount of information is requested you may be contacted to discuss clarifying or narrowing your request. Therefore, please choose your preferred manner of written communication to be used should the City need to request clarification or provide you with a cost estimate.
20. In what format do you wish to receive the information?
    Requested items will not be mailed, emailed, or faxed until payment is received.
22. Mail
    -- Select One --YesNo
23. Email
    -- Select One --YesNo
24. Fax
    -- Select One --YesNo
25. Pick Up
    -- Select One --YesNo
27. Police Recording Requirements
    If you are requesting video footage from the Police Department, the following information must be included in your request. * Time and date of recording. * Specific location where the recording occurred. * Name of one or more individuals known to be a subject in the recording.
29. Description of the Information Requested: (NOTE: Describe the information as precisely as you can.)*
    If requesting an Accident or Incident Report, please include report number and date of event.
31. Date Range
    Please specify dates or approximate dates of requested information if known.
33. Under the Public Information Act, some categories of information do not have to be released. Exceptions to disclosure fall into two general categories: 1) mandatory exceptions that make information confidential and require a governmental body to withhold information, and 2) discretionary exceptions that allow but do not require a governmental body to withhold information.
    Click here for information about mandatory and discretionary exceptions.

    In most instances, a governmental body is required to request a decision from the Attorney General in order to withhold information from a requestor. However, a requestor may permit a governmental body to redact information without requesting an Attorney General decision. You are not required to agree to the redaction of any information responsive to your request, but doing so may streamline the handling of your request. If you agree to redactions in this request, then you may request the redacted information in a future information request.
35. Do you agree to the redaction of information that is subject to mandatory exceptions, provided such redactions are clearly labeled on the information you received?
    -- Select One --YesNo
36. Do you agree to the redaction of information that is subject to discretionary exceptions, provided such redactions are clearly labeled on the information you receive?
    -- Select One --YesNo
38. NOTES:
40. • There is no requirement for a governmental agency to create new documents or answer questions; the City will search existing records for responsive information.
41. • The City has 10 business days to reply to your request; however, the City will promptly produce information as soon as possible under the circumstances without delay.
42. • If a request for information will result in charges of more than $40, a governmental body must send a cost estimate to the requestor before doing any work on the request.
43. • If the City requests clarification and we do not hear back from you within 61 days, your request will be withdrawn and you must submit a new request.
47. FOR OFFICIAL USE ONLY:
    Number of pages: _____________ Cost of copies: ________________ Labor cost: ____________________ Misc. notes: _____________________________________________________________________________ Total cost: ________________
49. ORR #:
    _____________________
51. 
Leave This Blank:


53. 1. Receive an email copy of this form.
54. Email address

    This field is not part of the form submission.

55. Submit

* indicates a required field