CITY OF DALLAS
PUBLIC RECORDS REQUEST FORM
Company:
Requestor’s Information:
Name:
Address (including City, State, ZIP Code):
Email: Phone:
Description of Records Requested (To expedite your request, be as specific as possible in
describing the records being requested):
How would you like to receive these records?
I want to inspect the requested records and do not want copies produced at this time.
I would like copies of the requested records and I agree to reimburse the City for the
costs of duplicating the requested records in accordance with ORS 192.324-192.329,
which includes the actual cost of making records available, prior to receipt of the
requested materials.
How would you like to receive these records? Pickup at City Hall Email US Mail
Requestor must read and sign:
I understand that every person has a right to inspect any public record of a public body in this state, except
as otherwise provided by ORS 192.311 to 192.478. Further, I understand that fees may be charged to
reimburse the City for its actual costs in making the records available. Such calculation may include staff
time, costs for summarizing, compiling, or tailoring a record to meet my request. I hereby request the City of
Dallas City Recorder to produce, to the best of their ability, the records specified above. Any fees must be
paid prior to release of the record(S) requested. A deposit for fees, based on the estimated cost, will be
required for any estimate above $25. For estimated above $25, the City will provide a written estimate of the
cost and will seek confirmation to proceed or cancel the request. I understand if the fee is not paid, or
additional requested information is not provided within 60 days, the request will be closed.
Signature: Date Submitted:
This form may be submitted:
• By email to: sam.kaufmann@dallasor.gov
• In person or via mail: City Recorder, 187 SE Court Street, Dallas, OR 97338
OFFICE USE ONLY
Date completed:
Date notified:
Date picked up/mailed:
Completed By: ______________
Signature: _____________
Request level: 1 2 3
Date acknowledged:
Estimated completion date:
Amount due:
$
City Recorder's signature: _____________
click to sign
signature
click to edit
![]()
