PUBLIC RECORDS REQUEST
Statement of Commercial Purpose
Pricing Computation Worksheet
This worksheet will be used to help determine the value of the requested public information on
the commercial market.
The specific information which will be used from the information requested is:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Please mark and complete the choice below that describes how the public information will be used.
This information will be used for:
☐ Sale or re-sale to _____________________________________________(market) for
$______________(cost) per _______________________.
☐ Producing a document, information or other material containing all of part of the information in
the public record (describe document/material and price):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
☐ Solicitation to ______________________________________________(market) for
______________________(what) or $_________________________________ (price).
☐ Soliciting a business or commercial relationship (describe relationship and give price or value):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
☐ Other purpose (describe purpose and give price or value):
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Name of Requestor: _____________________________________________ Date:__________________
For Department Use Only:
Cost for obtaining original or copies of requested information: $_________________________________
Cost of time, materials, equipment and staff to produce requested information: $___________________
Value of reproduction on commercial market as best determined by public body: $__________________
Total Due: $____________________________
