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Application for Open Records Request

This request is made under the Texas Open Records Act, Tex. Rev. Civ. Stat. Art 625217a. In accordance with Section 4 of the Act, which requires the custodian of records to produce public information for inspection, duplication, or both, in the offices of governmental bodies, I hereby request:
Requestor's Name:
Requestor's E-mail: Example:
Requestors Phone Number: (xxx) xxx-xxxx (Please include Area Code)
Extension: (Optional)
Records Request: Access to review the following (Please fill in as completely as possible):
Requestor's Address: Street Number and Street Name
Zip Code: