Records Request Form City Of Overland Park printable pdf download

REQUEST FOR RECORD INSPECTION AND/OR COPY

CITY OF OVERLAND PARK, KANSAS

Requester’s Information

Defendant Information

______________________________________

___________________________________

Name

Name_

(First, Middle Initial, Last, & Suffix)

Agency_________________________________________________

Possible Aliases _______________________________________

Street Address___________________________________________

Date of Birth__________________________________________

City, State, Zip____________________________________________

___Inspecting Records

___Copies of Records

Day Phone______________________ Fax_____________________

Method of Return: ___Mail ___Fax ___In Person

*** ONE DEFENDANT PER FORM PLEASE ***ALL RECORDS WILL BE CERTIFIED UNLESS REQUESTED OTHERWISE***

Case Information

Records Sought

__________________________________________

Entire Record

Disposition *

Case Summary**

Case Number, Violation Date, Charges

Other________________________________________________

__________________________________________

___Entire Record ___Disposition* ___Case Summary**

Case Number, Violation Date, Charges

Other________________________________________________

__________________________________________

___Entire Record ___Disposition* ___Case Summary**

Case Number, Violation Date, Charges

Other_________________________________________________

*Disposition includes a copy of the complaint/ticket, Judge’s bench notes, waiver of counsel, sentencing journal entry, and close-out orders.

**Case Summary is a printout of case number, charges, violation date, finding, finding date, and sentencing information.

CHARGES: A charge for providing copies of public records is authorized by state law and has been established by the City Governing Body. These

charges are set at a level to compensate the City for the actual costs incurred in honoring your request. The fee schedule established by the City is

posted in this office.

CERTIFICATION

I understand that K.S.A. 45-230, as amended, provides that except to the extent otherwise authorized, “No person shall knowingly sell, give

or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in

and derived from public records.”

I also understand that a violation of K.S.A. 45-230, as amended, is a Class C misdemeanor.

I hereby certify that I do not intend to, and will not: (A) Use any list of names or addresses contained in or derived from the records or

information for the purpose of selling or offering for sale any property or service to any person listed or to any person who resides at any address

listed; or (B) sell, give or otherwise make available to any person any list of names or addresses contained in or derived from the records or

information for the purpose of allowing that person to sell or offer for sale any property or service to any person listed or to any person who resides at

any address listed.

***SIGNATURE

_________________________________________________

Your copy of this form is your receipt

To Be Completed by Record Custodian

(

)

Date and Time of Request_______________________AM PM

Date and Time Access Provided______________________AM PM

The charge to your for copy(s) of the record(s) you request is: $__________

Records Custodian_______________________________________

___Prepaid