Resolution 2019-005: Information Request Form


Persons requesting photocopies of public information from the Town must complete this form, return it to the town clerk, and pay the applicable fees as indicated below.

Requester’s Name:_________________________
Date of Request__________________
Requester’s Address:_______________________________________________________
Requester’s Phone Number:_________________  Signature________________________
Description of the Information Requested: ______________________________________________________________ ____________________________________________________________________________________________________________________________________________________________

Town Use Only

The request is: [ ] Approved, [ ] Approved in Part, or [ ] Denied. Reason(s) for a partially approval or a denial: __________________________________________.
Fees applicable to the request:
Estimated Cost            Actual Cost

Labor               _______  x $26.00           _____________          ______________
# Hours          Hourly Rate
Photocopying ______  x $26.00            _____________          ______________
Rate                 Hourly Rate
Mailing                                   COST                     _____________          ______________
Other Costs     ____________            _____________          ______________                                ____________________              _____________          ______________

Totals: _____________*        ______________

Difference:________ [ ] To be paid by requestor
[ ] To be refunded by Town.

*If the total estimated cost exceeds $50, the requestor must pay the entire estimated amount before the Town will undertake to satisfy the request. If the actual cost is less than the estimated cost, the Town will refund the difference at the time the copies made available to the requestor. If the actual cost is more than the estimated cost, the requestor must pay the additional amount before receiving the copies.

Adopted this 9th day of April 2019.

Approved by Supervisors Charles Kuettel, Douglas Dressen and Don Swanstrom; and attested by Clerk Lita Wallace.