►Attention Requestor: 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 that are 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 up to ten (10) days to determine whether the documents requested are disclosable records.  

The City of Lake Elsinore charges $0.26 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. 81008).  Public records are accessible at all times during regular office hours and can be inspected at no charge with advanced notice.

1

Requester Information

 *

Requester Information

First Name	Last Name	Mailing Address
City	State	Zip Code
Phone Numberext.	Fax No.ext.	Email

2

Information Requested

 *

Information Requested

Date Range for Documents Requested (If Applicable)	Type of Document Requested	Preferred Format if Available
Address and Description of Documents Requested

3

Information Requested

Information Requested

Date Range of Documents Requested (If Applicable)	Type of Document Requested	Preferred Format if Available
Address and Description of Documents Requested

4

Signature 

By submitting this request, I understand that I am responsible for all charges applicable by law for the reproduction of said records and that the City does not have to produce records in a format in which they do not currently exist.

Name

5

INTERNAL USE ONLY

INTERNAL USE ONLY

Date Received	Department Routed To:
Request No.	Date Due

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