Public Records Request

*Mr. Ms.

*First:

Middle:

*Last:

Company:

*Daytime Phone:

(xxx-xxx-xxxx)

Cell or
Other Phone:

*Mailing Address:

Suite/Apt.

*City:

*State:

*Zip:

*Email Addr:

*Re-Enter
Email Addr:

Preferred
Delivery Method:

Fax Number:

General Public Information Request

Labels flagged with a * indicate a required field.

*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.

*Please select one: YES NO

*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.