Open Records Request FormCITY OF NEDERLAND
OPEN RECORDS/INFORMATION REQUEST FORM
UNDER THE TEXAS PUBLIC INFORMATION ACT (TPIA)
All requests must be in writing and directed to the City Clerk, City of Nederland, P.O. Box 967, Nederland, TX
77627, Fax: (409) 723-1550, Email: @ci.ned erland.tx.us. Please print or type: Name of Person Making Request: Address: City/State/Zip Code: Phone Number: Drivers License No.: Signature: Date of Request:
Detailed Description of Information Sought (please be as specific as possible):
(Check one) Information Format: (a) paper copies
(b)electronic format (diskette, CD, DVD)
(Check one) Transmission/Delivery: (a) U.S. Mail (additional charges may apply)
(b)Email (if possible)
(c)Review at City Hall/Public Works/Police Department
(d)Pickup upon Notification
(e)Fedex (additional charges will apply)
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The information requested will be supplied upon receipt of an interpretation that the information sought is not expressly prohibited by law. ***********************************************************************************************************
For completion by City only:
Date Received by City Clerk: Disposition:
(a)Provided the following information for viewing:
$ (fees assessed) (date)
(b)Provided copies of the following information:
$ (fees assessed) (date)
(c)Sent to Attorney on (date)
(b)AG Opinion requested on: (date)
(b)AG Opinion (number) received on (date)
Notes:
City Clerk Signature: