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Request for Public Records

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Step One

Name of Organization
Requester's Name
Phone Number
Address
Town/State/Zip
Email Address
Check All That Apply
1. I wish to inspect these items
2. I would like copies of these items
3. I would like to both inspect/obtain copies of items
4. I would like to receive documents electronically
5. I would like to receive the documents by fax
Is this request for commercial purposes?
1. Yes
2. No
Please describe in detail the public records being requested:
Signature of Persons Requesting Records
By checking this box, I authorize my signature.
1. Signature
Date
Date
Village of Indian Head Park Freedon of Information Officers
Administrator John DuRocher
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