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2. Subject*
   -- Select One --Data Request
3. Today's Date*
5. Name (Last, First, M.)
7. Street Address
9. City
10. State
11. Zip Code
13. Phone
14. Fax
16. Email Address*

18. *An email address is required to complete the online request. If you do not want to provide your email address as part of your data request, please stop in to City Hall to make your request in person or call the City office.

20. Are you the subject of the data you are requesting?*
    -- Select One --YesNo
22. Comments or Description of Information Requested*
24. Please indicate how you would like to receive the responsive data:*

    1. Inspection
    2. Paper copies (fees may apply)
    3. Electronic copies (fees may apply)
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field