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2. Requester's Name*
3. Email Address*
5. Mailing Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
13. Requested Information*
    Please be as detailed as possible: include names, dates, subjects, meeting dates, resolution and ordinance numbers, project names, etc.
15. Type of records:*

    Is this a request for:

    1. Examination of public records
    2. Copies of public records
16. Photocopies:*

    If you are requesting photocopies of public records, please complete the following:

    1. Color copies
    2. Black and white copies
    3. Single sided
    4. Double sided
18. Number of copies:*
    How many copies of the records do you want?
19. Format:*
    -- Select One --In personMailFlash driveEmailCD/DVD

    How would you like to receive the copies?
21. Acknowledgement:*

    The City will provide up to $100.00 of City staff time for supervision or gathering records free of charge with respect to each Public Records request. If the City estimates that the cost of responding to a request will exceed $100.00, the person requesting records will be provided with an estimate of total costs, and the person must agree to pay the total costs above $100.00 associated with responding to the request (whether less than, more than, or the same as the estimate) before records will be gathered or copies will be made. If the City estimates that the cost of responding to a request will exceed $150.00, the person requesting records must pay the estimated costs above $100.00 before records will be gathered or copies will be made. If actual costs are less than the estimate, any overpayment will be refunded; if actual costs are more than the estimate, the additional amount must be paid before the records or copies will be released. I certify that I understand I will be charged for the City’s costs related to the examination/copying of public records, and the records will not be released to me without payment.

    1. Yes
    2. No
23. Submit to:*

    Requests for Police Information go to University Heights Police Chief. All other information requests go to City Clerk. All requests should be returned to either of the above custodians of records by email or at the following address: University Heights City Office 1302 Melrose Ave. University Heights, IA 52246

    1. Police information (goes to Police Chief upon clicking "Submit")
    2. All other information (goes to City Clerk upon clicking "Submit")
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25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit Submit and Print

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