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2. Date of Submission
   Date of Submission
3. Open Records Request # ______________________
   (Office Use Only)
5. First Name
6. Last Name
8. Company / Organization Name (if applicable)
10. In order to respond to your request, please provide at least one method of contact below.
12. Mailing Address (Number & Street)
13. Apt. / Suite
15. City
16. State
17. Zip Code
19. Email Address
21. Phone Number
22. Fax Number
24. Delivery of Records (select one)

    1. Email to address provided above
    2. Regular Mail to address provided above
    3. Fax to number provided above
    4. Pick up in person
26. Please provide as much detail as possible such as report numbers, time-frame of records, date and place of incident, etc. The Public Information Act does not require a governmental body to prepare new information in response to a request, to prepare answers to questions or to complete legal research. The Act only applies to information already in existence as of the date of the request.
28. Service / Report Number
29. Date of Occurrence
30. Time of Occurrence
32. Name of Person Listed in Report
33. Exact Location / Address of Occurrence
35. Relationship to Person Listed in Report (select one)

    1. Self
    2. Parent
    3. Spouse
    4. Legal Counsel/Attorney, List Client's Name to the right
    5. Other, explain below
36. Client's Name
38. Other Relationship:
40. Information Request - Describe the EXACT information you are requesting. Include any details that may help the departments locate the records. (NOTE: One records request accepted per form. Failure to limit one records request per form will result in additional delays in processing the request.)*
42. Date Range:
43. From Date
44. to
45. End Date
47. Attach a File
49. Attach a File
51. Attach a File
53. Consent to Redaction
55. Explanation of exceptions to disclosure of certain records or portions of records:
57. Under the Public Information Act, some categories of information do not have to be released. Exceptions to disclosure fall into two general categories: 1) mandatory exceptions that make information confidential and require the City to withhold the information, and 2) discretionary exceptions that allow, but do not require, the City to withhold the information.
58. Mandatory and Discretionary Exceptions
    You may find information about mandatory and discretionary exceptions here.
60. In most instances, the City is required to request a decision from the Texas Attorney General in order to withhold information from a requestor. However, a requestor may permit the City to redact information without the need for requesting an Attorney General decision. You are not required to agree to the redaction of any information responsive to your request, but doing so may streamline the handling of your request. NOTE: If you agree to redactions in this records request, then you may still request the redacted information in a future records request; but the City will seek an Attorney General ruling regarding the release of the information.
62. Please answer the following questions:
64. 1. Do you agree to the redaction of information that is subject to mandatory exceptions? EXAMPLES: Dates of birth of living persons, Driver's license numbers, License plate numbers, Credit card numbers, Insurance policy numbers, Juvenile offender records, Child abuse investigations, Peace officer's home address, Peace officer's family member information
66. 1. Yes (If YES, the City will release the requested records to you with confidential information, if any, redacted and clearly labeled.)
    2. No (If NO, and the records contain confidential information, the City may seek a ruling from the Texas Attorney General regarding whether the confidential information, if any, may be released.)
68. 2. Do you agree to the redaction of information that is subject to discretionary exceptions? EXAMPLES: Attorney-Client communications, Information related to pending litigation, Police officer photographs, Matters under police investigation, Drafts of policymaking documents, Audit working papers, Competitive bidding information before contract awarded
70. 1. Yes (If YES, the City will release the requested records to you with such information, if any, redacted and clearly labeled.)
    2. No (If NO, the City will seek a ruling from the Texas Attorney General regarding whether such information, if any, may be released.)
72. Pursuant to the Public Information Act, Texas Government Code, Section 552, I hereby request the following information currently existing in the records of the City of Mesquite, Texas. I understand that there may be charges assessed for duplication or access to such records and prepayment may be required prior to preparation of the requested copies of such records.
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74. 1. Receive an email copy of this form.
75. Email address

    This field is not part of the form submission.

76. Submit

* indicates a required field