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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. Records*
    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. Department*

    1. Police
    2. Building
    3. Public Works
    4. Clerk

    1. Community Development
    2. Administration
    3. Finance
    4. Other
18. Signature of person making the request
    The City will respond to this request within three (3) business days.
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. Charges:
    A charge for providing access to public records is authorized by state law and has been established by the city governing body. These charges are set at a level to compensate the city for the actual costs incurred in honoring record requests.
    
    Printed pages @ $0.25 per page.
    Hours @ $20.00 per hour
    
    Complete fee schedule can be found on the website or at City Hall. If you have questions regarding charges, 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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