* Indicates a required field

The information may or may not be available at the time requested or may not be available for public inspection. Should this occur, you will be informed, in writing and within 10 business days, of a date when the information will be available.

Name*


Phone*


Representing Company or Firm


Mailing Address*


City*


State*


Zip*


Email*


Date of Request*


Public Information Request

In accordance with the provisions of the Public Information Act, I hereby request copies of the following *

(please be specific)

WAIVER: Do you give permission to redact (remove) any information that is confidential pursuant to the Attorney General's Public Information Act, Sections: 522.101: Judicial Decisions: 552.102: Employees' personal privacy; 522.117: employee address, telephone nos., Social Security Nos, personal family information; 522.1175: personal information of security officers; 522.130(a); Driver's License , Permit, Title, Registration, Personal ID; 522.137: email addresses when communicating electronically with governmental body.*

 Yes
 No

Electronic Signature*
First M. Last
If you need additional assistance, please contact the City Secretary's Office at 936.258.2642 ext. 1117

Approval for Release of Public Records
Internal use only

Date Received


Date Released


Fees


Approved for Release by

Approval for release by City Secretary, City Manager City Attorney only

City Attorney Opinion

 Yes
 No

Comments


AG Opinion

 Yes
 No

Date Submitted


Date Returned


Approved by AG

 Yes
 No

 Receive an email copy of this form.

Email address

This field is not part of the form submission.