For Police or Municipal Court Records, Please Contact Those Departments Directly
*The City will not recognize/accept any other means of public records requests.
Requester Information (Please print clearly):
Name: Request Date:
Mailing Address:
Daytime Phone: Email Address:
Fax Number:
Preferred method of contact: Mail Phone Email
Is this request related to a lawsuit in which the City of Lebanon is a party, or a tort claims notice filed with the
City of Lebanon?
Yes No If Yes, claimant name and incident date: / /
Copies may be furnished without charge or at a substantially
reduced fee if the custodian determines that the
waiver or reduction of fees is in the public interest because making the record available primarily benefits and
will be distributed to the public at large, not an individual or group. Does this request primarily benefit the
general public?
Yes No If Yes, please describe the particular or specific public benefit below in
the “Description of Records Requested” box.
Description of Records Requested (Describe in detail the type of document, date, author, title, etc. If you need
more room, please attach additional sheet(s). Please indicate if you want to inspect the records or if you need certified
copies of the records. If no indication is made, regular copies will be provided):
Preferred method of receiving the described records: Mail Email Fax
Note: Additional charges ma
be assessed, e.g.
ostage or staff time for faxing material.
The City will respond to your request as soon as practicable and without unreasonable delay.
If the estimated costs involved in fulfilling your request exceed $25, the City will advise you of the estimated costs and
require your approval before beginning the request.
If the fee estimate exceeds $100, a 50% deposit may be required to begin work.
Full payment of the total amount of costs incurred is required before the public records are inspected or copies are
released.
I HAVE READ AND AGREE TO COMPLY
WITH THE ABOVE CONDITIONS, and further agree to pay the cost of fulfilling this Public
Records Request per the conditions set forth above. These costs may include the cost of searching for records, reviewing records to
redact exempt material, supervising the inspection of records, copying records, certifying records and mailing records. I agree to pay a
maximum of $25 without further approval.
Signature of Requester Date
City Recorder’s Office
925 Main Street
Lebanon, OR 97355
541.258.4905 Phone
541.258.4950 Fax
ksc
heafer@ci.lebanon.or.us
City Staff: All Record Request Forms, along with City Response Forms, are filed with the City Recorder
PUBLIC RECORDS
REQUEST FORM*
click to sign
signature
click to edit
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