Fillable Records Request Form printable pdf download

City of Des Moines, Iowa Records Request Form

(Exhibit A)

REQUESTOR’S INFORMATION (please print)

1. Name: ____________________________________________________________________________

2. Company Name (if applicable):_________________________________________________________

3. Mailing Address: ____________________________________________________________________

4. Daytime Phone Number: _______________________________

5. Alternate Phone Number:_______________________________

6. Fax Number:_________________________________________

7. Email Address: __________________________________

REQUEST (Please be as detailed as possible; include names, dates, subjects, meeting dates, resolution and

ordinance numbers, project names, key words, etc.)

_________________________________________________________________________________________

Iowa Code Chapter 22 gives every citizen the right to examine public records and to copy those records unless

their access is expressly prohibited. The City of Des Moines staff should not be expected to abandon or neglect

their regular public duties to comply with record requests and thus need sufficient time to make and deliver any

requested information. If the requested material potentially contains confidential information or is otherwise

exempt from disclosure, additional time may be required for review and possible redacting of the material. All

requests will be processed in accordance with applicable procedures and rules. Note: If a deposit is required,

no work will begin on the request until a minimum of 50% of the estimated deposit is received.

________________________________________________

________________________

Signature and Printed Name of Requestor

Date of Request

Details of Request (for office use only)

1. Request Received via:

Fax

Mail

In Person / Verbal

2. Requesting:

Paper Copies

In-Person Examination

CD/DVD

Other ________________

3. Request Submitted on: ____________________________________________ (include date and time)

4. Department/Employee Receiving Request:________________________________________________

5. Date on Which Department Director Reviewed Request:_____________________________________

6. Date on Which City Attorney’s Opinion Sought (if applicable): __________ Attorney Name__________

Records Request Form (page 1 of 2)

Records Request Form