Request Form For Public Records printable pdf download

OFFICE USE ONLY

CASSIA COUNTY

Date Received ____________________

1459 OVERLAND AVENUE / BURLEY, ID 83318

Received by _____________________



Mailed

Faxed

Walked In

REQUEST FOR PUBLIC RECORDS

Payment received for one (1) copy

each of ____

documents.

I hereby request, pursuant to Idaho Code § 74-102

Amount Received _____________



these records specifically pertain to myself; or,

Receipt Number ______________



to examine the following record(s); or,



a copy of the following record(s).

CLEAR DESCRIPTION OF RECORD(S) SOUGHT: _____________________________________________

_________________________________________________________________________________________

Date of Request _______________________________________

PLEASE PRINT CLEARLY

Name: ___________________________________________________________________________________

Address: _________________________________________________________________________________

________________________________________________________________________________________________________________

City

State

Zip

Email Address: _______________________________________________________

Day time Phone Number:

Fax Number: ______________________

Signature _________________________________________________________________________________

I acknowledge by my signature that the records sought by this request will not be used for a mailing list

or telephone list as set forth in Idaho Code § 74-102.

TO BE COMPLETED BY THE CUSTODIAN OF RECORD(S):

1.  Your request has been approved. See attached documents or please contact the undersigned to arrange a time to

examine the records. (This may be a partial approval. See items 2 or 3 regarding records not located or deemed

___________________

exempt.)

Number of Copies Provided

$ ____________________ Total Cost

2.  It has been determined that additional time is required to locate or retrieve the records you have requested.

Said records shall be available on_______________________ _ , or further information will be provided regarding

your request. (No longer than 10 days from request.)

3.  Your request has been denied as following records are exempt from public disclosure for the stated reason.

Idaho Code Section

_________________________________

3.  The attorney for the entity has reviewed your request and this response.

NOTICE: PURSUANT TO IDAHO CODE § 74-115 YOU HAVE 180 DAYS TO APPEAL THIS DECISION BY FILING A

PETITION IN STATE DISTRICT COURT IN THE COUNTY WHERE ALL OR PART OF THE RECORDS ARE LOCATED.

Custodian:_________________________________________________________________________________________

Department: __________________________________________

Telephone:______________________________

Request Form For Public Records

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