2. Person seeking records
4. First Name
5. Last Name
7. Address 1
9. Address 2
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Email Address*
18. Records*
    Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible.
20. Record Format

    Please indicate the format you wish to have the requested record(s) produced in:

    1. Electronic
    2. Paper
21. Method of Delivery

    Please indicate the method by which you would like to receive the requested record(s):

    1. E-mail
    2. In Person
    3. Standard Mail
    4. Electronic Media
23. Department*

    1. Police
    2. Fire
    3. Public Works

    1. Clerk-Treasurer
    2. Economic Development
    3. Water

    1. Sewer
    2. Other
25. Signature of person making the request
    The Village will respond to this request within a reasonable amount of time.
27. Do you agree?

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature, and 3) there may be a cost and payment may be required prior to release of documents.

    1. I Agree
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29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

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