Fillable Form 7: Public Records Request Form (City of Stayton)

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Form 7: Public Records Request Form (City of Stayton)

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The Form 7: Public Records Request Form (City of Stayton) form is 1 page long and contains:

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  • 14 check-boxes
  • 16 other fields

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File type: PDF

U.S.A. forms for City of Stayton

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Public Records Request Form
Stayton City Hall
362 N. 3
rd
Avenue
Stayton, OR 97383
(503)
7
69-3425
(503) 769-1456 (FAX)
aangelo@ci.stayton.or.us
All Public Record Request Forms are filed with the Administrative Services Manager
Requester Information (Please Print Clearly):
Name:
Request Date:
Mailing Address:
Daytime Phone:
Email Address:
Fax Number:
Preferred method of contact: Mail Phone Email
Request for: General Public Records Discovery for Stayton Municipal Court
View or Copies of Records? View Public Record(s) at City Hall Copies of Public Records
Digital Copies Paper Copies
DESCRIPTION OF RECORDS REQUESTED
Describe in detail the type of document you are requesting. Include name, date, incident number, date of birth, address, author, title, etc. The
more detail, the better. If you need more room, please attach additional sheets.
Police Incident Report (Incident #, Date, Time, Location): Open Records Check (Include name and DOB or Location):
Preferred method of receiving the descri
bed records:
Pick-Up Email US Mail (postage cost will be added)
The City will respond to your request as soon as practicable and without unreasonable delay.
If the estimated costs involved in fulfilling your request exceed $25, the City will advise you of the estimated costs and require
your approval before beginning the request.
The City requires a deposit in the full amount of the estimated costs before expending additional resources on the request.
If the actual costs of completing the request exceeds the estimate, the City will not release the records until the actual costs are
paid in full. If the actual costs of responding to the request is less than the estimated cost, the balance of the requestor’s deposit
will be refunded.
I have read and agree to comply with the above conditions, and further agree to pay the cost of fulfilling this Public Records Request according to the
conditions set forth above. These costs may include the cost of searching for records, reviewing records to redact exempt material, supervising the
inspection of records, copying records, certifying records and mailing records. I agree to pay a maximum of $25 without further approval.
Signature of Requester Date
CITY OF STAYTON USE ONLY
Approved (date & initial)
Balance Paid:
Denied (date & initial)
Requestor notified of status of request (date / time / by):
Revised 01/2020
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Form 7: Public Records Request Form (City of Stayton)

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Completed 16 July 2020

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