APPENDIX B: PUBLIC RECORD REQUEST FORM

 

Town of Roanoke P.O. Box 328 Roanoke, Indiana 46750 [phone] PUBLIC RECORD REQUEST FORM DEPARTMENT (x By Appropriate Department) __________ Clerk-Treasurer’s Office __________ Street/Sewer Department __________Town Council Type and/or Description of Records Requested: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Requested by: _________________________________________________________________________    Printed Name                        Signature ______________________________________________________________________________________ To be filled in by Town Representative: Date Requested: ___________________ Number of Copies: _________________ Charge: __________________________ If denied, Reason: _______________________________________________________________________ Name/Title of Town Representative denying request: ____________________________________________ If granted, date copies of record(s) available: __________________________________________________

 

(Prior Code, Ch. 34, App. B) (Ord. 2000-8, passed 9-5-2000)