Public Records Request
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Mr.
Ms.
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First:
Middle:
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Last:
Company:
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Daytime Phone:
(xxx-xxx-xxxx)
Cell or
Other Phone:
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Mailing Address:
Suite/Apt.
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City:
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State:
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Zip:
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Email Addr:
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Re-Enter
Email Addr:
Preferred
Delivery Method:
Select One
Copy
Electronic
Inspect
Fax Number:
General Public Information Request
Labels flagged with a
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indicate a required field.
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In accordance with the provisions of the Public Information Act, I hereby request copies of the following (please be specific)
WAIVER
: Do you give permission to redact (remove) any information that is confidential pursuant to the Attorney General's Public Information Act, Sections: 522.101: Judicial Decisions: 552.102: Employees' personal privacy; 522.117: employee address, telephone nos., Social Security Nos, personal family information; 522.1175: personal information of security officers; 522.130(a); Driver's License, Permit, Title, Registration, Personal ID; 522.137: email addresses when communicating electronically with governmental body.
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Please select one:
YES
NO
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Requestor Signature:
If you need any further assistance, please contact the
City Clerk's office at 281-420-6504.
Angela Jackson, Public Information Officer
Alisha Segovia, Open Government Specialist
Public Records Request by Destiny Software, Inc.