HomeMy WebLinkAboutPublic Records Request FormOct 10 11 09:13a Promethean Biofuels
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CITY OF Completion Information For Official Use Only
— Ti N R Request No. Date:
�� ti..J �SI o, Number of Copies x.250 _ $
D KEAm EXTIREME
♦'� Other Services: $
(Type)
City Clerk's Office Request Completed By:
130 S. Main Street, Lake Elsinore, CA
(951) 674 - 3124, Ext. 269
PUBLIC RECORDS REQUEST FORM
►Attention Request r: To expedite your request, please fill out this form completely and identify specifically the
type of records you are requesting. Where applicable, the title of the document or other specific identifying
information is advisable. NOTE: The City is not required by law to create a new record or provide public records
exempt by express provisions of law from disclosure. If the City is required to compile data, write programming
language or to construct a computer report to extract data, the requestor will be charged for time and material. The
City has ten (10) days to determine whether the documents requested are disclosable public records. I
understand that the City of Lake Elsinore charges $0.25 per page to produce copies of identifiable records and
$0.10 per page for copies of statements filed pursuant to the Political Reform Act (G.C. 81005). Public records are
accessible at all times during regular office hours and can be inspected at no charge.
Re uestor Information
Name:
f f
Date:
Mailing Address:
ional)
State: Zip Code:_ —
(op.,
City.
Phone No.:
Fax No.: �Q l -Mail:
Requested Information
Time Period of Documents
Requested: From: a-E.- l d f zo l To: }O
Signature of Request
r:
INTERNAL_ USE ONLY
Recei t o—fRc
quest Information Completion of Request Information
Department Routed To:
Department Submitting Information:
Date Received:
Date Submitted to City Clerk's Office:
Staff Member Si nature:
City Clerk's Office Verification Initial Only).