Fillable PUBLIC RECORDS (APRA) REQUEST BUILDING DEPARTMENT CITY OF (City of South Bend)

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PUBLIC RECORDS (APRA) REQUEST BUILDING DEPARTMENT CITY OF (City of South Bend)

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The PUBLIC RECORDS (APRA) REQUEST BUILDING DEPARTMENT CITY OF (City of South Bend) form is 1 page long and contains:

  • 1 signature
  • 10 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of South Bend

BROWSE CITY OF SOUTH BEND (IN) FORMS

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PUBLIC RECORDS (APRA) REQUEST
BUILDING DEPARTMENT
CITY OF SOUTH BEND
Name of Requesting Party:
Address of Requesting Party:
City:
State:
Zip:
Telephone:
Date of Request:
Time of Request:
Submitted (check one):
□
In Person
□
Mail, Email or Facsimile
Signature of Requesting Party:
Property Address of Information Requested:
Records Requested. Use the back of form if additional space is needed.
____ PERMITS
____ INSPECTION REPORTS
____ SITE PLAN
____ CERTIFICATES OF OCCUPANCY
____ BUILDING VIOLATIONS
OTHER (PLEASE BE SPECIFIC): _________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Check one: I request to
□ INSPECT or □ BUY copies of the records requested.
Check one:
I request to receive my records by:
□
in-person pick-up; or
□
REGULAR MAIL; or
□
EMAIL; or
□
FAX
*** SUBMIT REQUESTS TO THE LEGAL DEPARTMENT (apra@southbendin.gov) ***
CITY OF SOUTH BEND USE ONLY
Request Received By:
Department:
Date and Time Received:
Acknowledged Receipt:
□ Email □ Telephone □ In Person Acknowledgement Form
Department Comments:
__________________________________________________________________________________________________________
ATTORNEY DECISION
INFORMATION IS DISCLOSABLE _______ INFORMATION IS NOT DISCLOSABLE _______
Attorney Comments and Instructions: __________________________________________________________________________
Attorney Signature: __________________________________________ Date of Decision: ____________________________
Letter sent (Date): Decision Sent To: Date: By:
Informed requesting Party that information is ______ DISCRETIONARY DISCLOSURE or _______ NON-DISCLOSABLE
Date: Signature: □ In Person □ By Telephone □ By Email
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PUBLIC RECORDS (APRA) REQUEST BUILDING DEPARTMENT CITY OF (City of South Bend)

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Completed 16 July 2020

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