Public Records Request Form

Public Records Request Form

Please fill out this form if you are requesting an inspection or copies of public records. In an effort to fill your request in the shortest amount of time, please be as specific as possible.

Fill in your information on the computer then print and apply signature, & date in pen before submitting to fire department.

Public records may be requested, inspected and copies obtained during normal business hours of Monday through Friday, 8:30 am to 5:00 pm. In some cases records may require retrieval and therefore may not be immediately available for inspection. Every effort will be made to respond to the open records request as soon as it is practicable and without delay.

The cost of photocopying records shall be 25¢ per side of page, which has been calculated to be the actual, necessary and direct cost of reproduction. In some cases some response cost may go beyond simply copying a requested record. In these cases, the Records Custodian may charge for any and all costs associated with complying with an open records request up to and including applicable shipping, mailing and hourly wages or Record Custodian or designee thereof. Per 1935(3)(f) a prepayment of such cost associated with an open record request in access of $5.00 may be required prior to processing such open record request.

Requestor's Information (Please Print)

Name:
FIRST NAME MIDDLE INITIAL LAST NAME

Group:
COMPANY NAME OR GROUP AFFILIATION

Address:
ROUTE OR POST OFFICE BOX NUMBER

Preferred Contact
Phone Number: - -

Fax: - -

E-Mail:

Document to be Picked Up: Mailed:

Reason requested:

Acknowledgement that requestor inspected or received
a copy of document requested.

_______________________________________________________
SIGNATURE DATE

Please allow at least 10 days for information to be researched. Your request will be given priority and
you will be notified as soon as the records requested are available for your inspection or release. Records will be available for pickup 7 days from completion of contact date.
Any information given orally or in writing by City Officials may be subject to errors or omissions and shall not be binding liability upon the City of Lake Geneva.

MUNICIPAL RECORDS USE

Date stamp when received:

Time received: _ _:_ _ AM PM

Received by: ________________________

Date completed: ____/____/______

Time completed: _ _:_ _ AM PM

Access to documents:
 Approved  Denied

Records Custodian:

______________________________________

No of pages: ____ Fees received: $__________

Remarks / Actions:
______________________________________

______________________________________