PUBLIC RECORDS REQUEST FORM
I would like the documents delivered to me by:
Mail (address listed above) Fax (listed above) Email (listed above) Will Pick Up For Review Only
The requested public record is strictly for:
My own personal use. On behalf of: _________________________________________________
Are you involved in litigation or appeal with the City of Homer? Yes No
If so, which case(s)? ___________________________________________________________________________
Does this request pertain to the above litigation(s)? Yes No
I understand that I will be charged a fee of 25 cents for each page that I request to be copied or provided by
electronic
transmission. I further understand that if it is determined that my request(s) will require more than five hours of
staff time per calendar month that I will pay, upon notification, the total actual personnel costs required to complete the
search and/or copying tasks per AS 40.25.110(c)
Signature: ________________________________________________________ Date: _____________________
Identify and describe the documents you seek. Be specific.
Title of Record: __________________________________________________________________________________
Date of Record: __________________________________________________________________________________
Description of Record: _____________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Department/City Manager Signature: __________________________________________ Date: __________________
Approved Denied Reason for denial: ______________________________________________________
Information on Alaska’s Public Records Laws can be found in Alaska Statues 40.25, and in Homer City Code 2.84.
Exceptions to the policy that a city document should be released to the public when there is a request can be found in Alaska
Statutes 40.25.120 and Homer City Code 2.84.020
Name: ____________________________________ Phone: _____________________ Cell: _____________________
Name of Business, Law Firm and/or Company: _________________________________________________________
Address: ________________________________________ City: _________________ State: _____ Zip: ___________
Email: _________________________________________________________ Fax: ____________________________
Public Records and the Law
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