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Request for Public Record

  1. Pick One

  2. One Sided 8.5 inches x 11 inches, Fee: $0.15
    One Sided 8.5 inches x 14 inches, Fee: $0.15
    One Sided 11 inches x 17 inches, Fee: $0.20
    Two Sided Copy, Fee: $0.20
    Certified Copy $1
    CD/Cassette Tape/DVD, Fee:$7
    Large Format Copies-Fees Based on Outsourcing Costs

    Fees Charged are based on the custodian or his/her designee's rate of pay, and will be charged for extensive time, use of information technology, resources, or clerical labor. Extensive means more than 15 minutes to locate, review for confidential material, remove confidential material, copy and re-file the requested material. Charges will be calculated at the current rate of pay for the records custodian or his/her designee.

  3. Requested Method of Delivery

  4. Time X Rate

  5. Time X Rate

  6. ______ X 0.15

  7. ______ X 0.15

  8. ______ X 0.20

  9. _____ X 1

  10. Deposit Required?

  11. Deposit/Payment Received?

  12. Refund Required?

  13. Le ave T his Bla nk:

  14. This field is not part of the form submission.