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2. Date and Time*
   Date and Time

   Date and Time
4. Name*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. Subject Matter*
17. Manner of Compliance*
    -- Select One --Personally InspectPersonally CopyCause to be Copied
19. Manner of Delivery*
    -- Select One --By Mail to the Address AboveIn Person at Your Office

21. I have read and understand the "Resolution Adopting Procedures for Public Access to Municipal Records" and I further understand that the actual cost of compliance with my request, if granted, shall be borne by me including mailing costs, if applicable. I understand that any request shall be clear and concise and shall be directed toward only one subject matter. I also understand that the actual costs of compliance with my request, if granted, shall be paid by me in advance of the receipt of any information and that the City shall have up to 7 working days to deliver copies of records sought via this form. 

23. This Request is Directed To:*
    -- Select One --Animal ControlBuilding Inspection/Zoning DepartmentCity GarageCity ProjectsCode Enforcement Convention Center/Friendship CemeteryCourt DivisionFinance DepartmentFire DepartmentForensic DepartmentHuman ResourcesParks and RecreationPlanning/Community Development Police Department Public InformationPublic WorksOther (please specify below)
25. If selection not listed above please check other and specify department

    1. Other
26. Other Department
28. Approval Granted By:
29. ____________________________________________________
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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