APPLICATION FOR INFORMATION

(This form is for  convenience and not required for your request.)

APPLICATION FOR INFORMATION

(In compliance with the Freedom of Information Act, which changed January 1, 2010, you will receive a response within 5 business days)

 VILLAGE OF WESTVILLE

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* Required information.
Date: *
Time: *
Name of Applicant:
Address:
Telephone: *

IF PUBLIC BODY, BUSINESS ORGANIZATION, CIVIC ORGANIZATION OR OTHER:

Name of Organization:
Address:
Position of Application:

 

Request is for: *
Copies of Records (15¢ per pg after 50 pg)
Viewing of Records
Written description of public record requested with the description clear enough to help us identify exactly what you are requesting: *

-----------------BELOW THIS LINE FOR VILLAGE USE--------------------


REQUEST:  ALLOWED  DENIED     (CIRCLE ONE)

BY: _________________________ DATE/TIME RCVD. ______________

REASON FOR DENIAL: ______________________________________

PUBLIC ACCESS COUNSELOR CONTACTED:  yes   no (circle one)    date: _________

COPY FEES (15¢/pg. after first 50pgs) ______ pgs.   Fee_______   Pd.________

DATE DUE  ________   REASON FOR EXTENSION ______________________

First 50 pages, black and white, letter or legal size copies, no cost.
   
Additional pages, black and white, letter or legal, actual cost to 15¢.
   
Electronic records will be formatted subject to reimbursement for costs of recording medium.
Color copies or copies in a size other than letter or legal shall be reimbursed to actual costs.
   
Costs of certifying a record will be $1.00.

Records may be furnished without charge or at a reduced charge, as determined by the Village, if the person requesting the documents states the specific purpose for the request and indicates that a waiver or reduction of the fee is in the public interest.  Waiver or reduction of the fee is in the public interest if the principal purpose of the request is to access and disseminate information regarding the health, safety and welfare or the legal rights of the general public and is not for the principal purpose of personal or commercial benefit.