Request for Disclosure of Documents Under the Open Records Act

Request for Disclosure of Documents Under the Open Records Act
Requester Name

First NameLast Name
Requester

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Fax
Please enter a valid fax number.Format: (000) 000-0000.
Email
example@example.com
Pursuant to O.C.G.A. § 50-18-70 et seq., I am formally requesting to inspect certain public records. In particular, records requested for inspection are (please be specific and include addressing and time frame of records - i.e. from this date to this date):
Request
Date records are requested to be made available

MonthDayYear
Date
*Please note there is an additional charge of $10.00 per Zoning Verification Letter.
Record Delivery Method
*Please note that the following fees apply for printed records.

$0.10 per page copy (8 1/2 x 11)
$0.20 per page copy (11 x 17)
$2.00 per page for building plans
Record retrieval fees are calculated as follows:

The first fifteen (15) minutes at no cost.

Time spent after 15 minutes is calculated at the hourly rate of the lowest paid person working on the request. An estimated cost will be provided prior to initiation of record retrieval.
I agree to pay any copying and/or administrative costs incurred in fulfilling my requests to the extent permitted by Georgia law. Such costs may include charges per page and administrative charges for search, retrieval, and other direct administrative costs, such as administrative charges not to exceed the salary of the lowest paid full-time employee who, in the discretion of the custodian of the records, has the necessary skill and training to perform the request. The requester is not charged for the first fifteen minutes of time.
Name (Print)
Signature

Clear
Date Received

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Staff Member Receiving Request
Should be Empty: