Office of City Clerk
215 S. Broadway, Louisburg, KS 66053
913-837-5371 · louisburgkansas.gov
Request for Public Records
Name: _____________________________________________________________________________________________
Address: ___________________________________________________________________________________________
Phone: ____________________________________________ Fax: ____________________________________________
Please provide a specific description of the information that you are requesting.
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There is a charge of _______________ per hour, minimum charge _______________ plus _______________ per copy.
Office Use Only:
Date & Time information provided: _____________________________________________________________________
Charge for information: _______________________________________________________________________________
Paid by cash/check/credit card: _________________ Receipt #_________________________
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