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2. First Name*
3. Last Name*
5. Address 1*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address*
14. Record (s) Description*

    Please provide a specific description of the record(s) you desire to receive. Include record title, date, originating city agency/department, or any other pertinent information.

16. Approximate Date Record(s) Created

    Please provide a date range when the requested record(s) were created. (eg. "1998 to 2002", "01/2023 to 04/2023" etc.)

18. Signature of person making the request
20. Do you agree?*

    By clicking I agree, you agree and acknowledge that
    1) your application will not be "Signed" in the sense of a traditional paper document and
    2) by signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
24. Fees

    Fees for providing access to public records are authorized by state law and have been established by the city governing body. These fees are set at a level to compensate the city for the actual costs incurred in honoring record requests, including hourly staff time spent in retrieval, review and, when necessary, redaction of exempted content. You will be provided with an estimated total cost before any fees are incurred. 

    If you have questions regarding fees, please contact the City Clerk at (316) 744-2451.

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

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