TOWN OF PEQUAYWAN
ST. LOUIS COUNTY, MINNESOTA
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.
Date of Request__________________
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.