2. First Name*
3. Last Name*
5. Address 1*
7. Address 2
9. City*
10. State*
11. Zip*
13. Phone Number*
14. Email Address*
16. Is this a commercial request?*

    1. Yes

    1. No
18. Records*
    Please describe the public records you wish to recieve. In order to expediate the search for the records, please be as specific as possible.
20. Department*

    1. Police
    2. Building
    3. Public Works
    4. Clerk

    1. Community Development
    2. Administration
    3. Finance
    4. Other
22. Signature of person making the request
    The Village will respond to this request withing five (5) working days.
24. 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.

    1. I Agree
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25. 1. Receive an email copy of this form.
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