Feb. 2020
Requestor Information
Name: Date: Due:
Business/Agency:
Address:
City: State: Zip:
Email address: Telephone number:
I (we), the above named individual/business, hereby request the following information be provided under authority of the
Texas Open Records Act. I (we) understand that a fee(s) will be charged for the service(s) provided and that these charges
follow established city policy and state law. Any request for body camera footage must comply with Occupations Code
1701.661.
Requested Information
Date range: to Incident type:
Incident address:
☐
Specific Information Request
Names of person(s) involved:
Incident or call number:
☐
Statistical Information Request
Describe the information you need:
We w
ill attempt to provide you with the information you need using an existing report format. If you request data that is
not normally computerized, in a format that will require computer programming to produce, or historical data that requires
us to make off site archival searches, you may be required to pay for the actual cost we incur. In the event an additional
charge may apply, we will notify you before beginning the job.
Sign on
ly one (1) area – if both areas are signed, the request will be returned to you!
I agree to accept a redacted copy of the requested document/report, and
understand a redacted copy will be provided within ten (10) working
days form the date of the request
Signature:_________________________________
I do not want a redacted copy of the requested document/report and
agree to wait the required 45 to 55 days so the Texas Attorney General
Office can issue an opinion on what, if any portions, of the
document/report will need to be redacted.
Signature:_________________________________
* Your identity is not required for an information request under the Texas Open Records Act. However, if you are requesting a local
criminal history check or other name dependent report or service, your identity may be required in order to fulfill your request.
Open Records Request
Leander Police Department
705 Leander Dr
Leander, TX 78641
(512) 528-2800, (512) 528-2841 Fax
☐ Approved ☐ Denied
Date:________________
Employee #: __________
