Fillable PUBLIC RECORDS REQUEST FORM (Bal Harbour Village)

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PUBLIC RECORDS REQUEST FORM (Bal Harbour Village)

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The PUBLIC RECORDS REQUEST FORM (Bal Harbour Village) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

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PUBLIC RECORDS REQUEST FORM
Pursuant to Section 119.07, Florida Statutes, the below identified person hereby request to
Inspect or Receive a Copy (mark "X" as applicable) of the following records:
Date of Request:
Name of Requestor:
Type of Record(s):
Time Period For Record(s):
Mailing Address:
Phone #: Fax#:
Email:
Request Received By:
REQUESTOR CONTACT INFORMATION
It is NOT required that the Village Clerk obtain the name address, telephone number, or other personal
information from the person making the request, and such person may decline to provide such information. In the
event that the person making the request for public records declines to provide a written request, a written
request shall not be required, and instead the Village Clerk shall complete this form, in order to document the
request and the Village's compliance.
Bal Harbour Village Hall · 655 - 96
th
Street · Bal Harbour · Florida 33154
Phone 305.866.4633 · Fax 305.993.5163
Details:
Date:
SECTION TO BE COMPLETED BY VILLAGE STAFF
Request Assigned to:
Date Assigned:
Extensive Request:
YESNO
Date Completed:
IF NO, PLEASE SKIP TO REVIEW AND APPROVAL SECTION.
IF YES, PLEASE FILL OUT EXTENSIVE RESEARCH LOG.
EXTENSIVE RESEARCH REQUEST LOG
DATE(S) OF RESEARCH: HOURLY RATE: TOTAL HOURS/MINUTES: TOTAL AMOUNT PER DAY:
DUPLICATING COSTS (COPIES, CD) TOTAL:
GRAND TOTAL DUE:
Employee
Signature:
Date:
NOTES:
Village Clerk
Signature:
Date:
Dwight S. Danie
DATE PAID:
Payment Method/Info:
REVIEWED AND APPROVED BY:
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PUBLIC RECORDS REQUEST FORM (Bal Harbour Village)

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Completed 14 January 2021

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