(Note: Completion of this Form by Public is Optional)
Please be advised that I, ______________________________, requested to view the following records kept by the City of Parma: (describe as fully as possible, including dates and names)
1. _______________________________________________________________________________
___________________________________________________________________________________
2. _______________________________________________________________________________
___________________________________________________________________________________
3. _______________________________________________________________________________
___________________________________________________________________________________
Address of Requestor: ______________________________________________________________
Telephone Number of Requestor: ______________________________________________________
Signature of Requestor: ______________________________________________________________
Date Signed: _______________________________________________________________________
Below for Office Use Only
If employee is requesting to view his/her own personnel file, a driver's license or other photo ID must be provided. Provided? ______ Yes _______ No
In the event of a refusal or uncooperative requestor, please fill in to the best of your ability:
Description of documents requested: __________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Date Records Requested: ____________________ Date Records Provided: ____________________
Copies Requested: _______ Yes ______ No
Signature of City of Parma employee: _________________________________________________
Disposition: _______________________________________________________________________
(Res. 203-04. Passed 8-16-04.)