Date:  Name:
Address:  City:
State:    Zip Code:  
Phone No:  Email:

Records Requested; please be specific:


I would like to view the records.
I would like to receive a copy of the records.
I understand that I will be responsible for fees associated with research charges and/or copying charges as permitted by UCA 63G-2-203.
I authorize costs up to (If
 costs exceed the amount I have specified, I further understand that the office will contact me and will not respond to my request if I have not authorized associated costs.) 
I understand the City has ten (10) business days to respond to this request.

If the requested records are not public, please explain why you believe you are entitled to access.
I am the subject of the record.
I am the person who provided the information.
I am authorized to have access by the subject of the record or by the person who submitted the information; documentation required by UCA 63G-2-202 is attached. Please Explain:  

  I am requesting expedited response as permitted by UCA 63G-2-204(3)(b).
(Please attach information that shows your status as a member of the media and a statement that the records are required for a story for broadcast or publication or other information that demonstrates that you are entitled to an expedited response.)
_________________________________________________________________________________________________
City Use Only:
Request Received by:       Date:
Request Due (10 Business Days):
Request Completed by:   Date: