"*" indicates required fields Requestor's Name* First Last Phone*Email* Address* Mailing Address City State / Province / Region ZIP / Postal Code Photo of Drivers License*Max. file size: 50 MB.Description of Record Sought. (Records must be described with reasonable specificity)*I would like to view/inspect the record Yes No I would like to receive copies for the record. I understand that Harrisville City charges a $25 per copy fee for copies of records and that copies will be provided subject to fees being paid permitted in U.C.A 63-2-203. I authorize costs of up to $_____. If the costs are greater than the amount that is specified I further understand that the office will contact me and will respond to a request for copies if I have not authorized adequate costs. Waivers request fees may be filed pursuant to U.C.A 63-2-203(4) Yes No Authoirzed costs. (If you selected yes)Signature (If you selected yes)If the records requested are not public, please explain why you believe you are entitled to access I am the subject of the record I am the person who provided the information requested Pursuant to U.C.A 63-2-202, I am authorized to have access to the subject of the record or by the person who submitted the information as evidenced by documents filed and herein attached as required by law. Other If "other" please explainExpedited response is permitted only as outlined in U.C.A. 63-2-204(3) (b) I am requesting expedited response as authorized by law and I have attached documentation showing my status as a member of the media and a statement that the records are for media purposes; or other information that demonstrates I am entitled to expedited response Media DocumentationMax. file size: 50 MB. Δ
