Open Records Request To Inspect Public Records

Date(Required)

I request to inspect and/or receive copies of the following document(s)(Required)

(There is a $0.10 fee for each photocopy received. If the items are to be mailed, the amount of postage will also be charged. If the records are in a non-written format, the charge will be equal to the actual cost of reproduction.)

Printed Name -- Company Name (if applicable)(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone Number -- Fax Number(Required)

Email(Required)

Signature(Required)

THIS COMPLETED FORM SHOULD BE SUBMITTED TO THE LIBRARY DIRECTOR

Please do not fill below this line - For Mary Wood Weldon Memorial Library use only

Granted Request

The request is granted.

Total amount charged to applicant to fulfill request ($)

The request is denied based on the following exemption

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Donate Items

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Open Records Request To Inspect Public Records

THIS COMPLETED FORM SHOULD BE SUBMITTED TO THE LIBRARY DIRECTOR

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