PUBLIC RECORDS REQUEST FORM
The Tennessee Public Records Act (TPRA) grants Tennessee citizens the right to access open public records that exist at the time of the
request. The TPRA does not require records custodians to compile information or create or recreate records that do not exist.
To:
From:
Is the requestor a Tennessee citizen? Yes No
Request: Inspection (The TPRA does not permit fees or require a written request for inspection only
.)
Copy/Duplicate
If costs for copies are assessed, the requestor has a right to receive an estimate. Do you wish
to waive your right to an estimate and agree to pay copying and duplication costs in an
amount not to exceed $_________________? If so, initial here: ______________.
Delivery preference: On-Site Pick-Up USPS First-Class Mail
Electronic Other: ________________________
Records Requested:
Provide a detailed description of the record(s) requested, including: (1) type of record; (2) timeframe or
dates for the records sought; and (3) subject matter or key words related to the records. Under the TPRA,
record requests must be sufficiently detailed to enable a governmental entity to identify the specific records
sought. As such, your record request must provide enough detail to enable the records custodian responding
to the request to identify the specific records you are seeking.
___________________________________________ ____________________________________________
Signature of Requestor and Date Submitted Signature of Public Records Request Coordinator and Date Received
Note, Tenn. Code Ann. § 10-7-504(a)(20)(C) permits charging for redaction of private records of a utility.
(Governmental Entity Name and Name and Contact Information for the Public Records Request Coordinator)
(Insert Requestor’s Name and Contact Information (include an address for any TPRA required written response))
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