Bastrop County
PUBLIC INFORMATION RECORD REQUEST FORM
To: Bastrop County ___________________ Office
Re
quest is hereby made for copies of the following record(s):
(Indicate the document numbers, type of document, dates of interest, and the name of the document.
Attach an 8.5” X 11” sheet if necessary)
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REQUIRED APPLICANT INFORMATION:
Name: _____________________________________
Address: ___________________________________ E-mail: ______________________
Phone Number: _____________________________ Fax Number: _________________
Applicant’s Signature: _______________________ Date: _______________________
Preferred Method of Delivery (Check One) Mail E-mail Fax Pick up in Person
If you have any questions or concerns you may contact the
Bastrop County Human Resources Office at 512-581-7120.
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