PUBLIC INFORMATION REQUEST
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YOUR ADDRESS
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CITY, STATE & ZIP CODE
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AREA CODE & PHONE NUMBER Received by: ______Date: ______
______, am submitting this document as my Open Records request as stated below.
(PRINT YOUR NAME)
I understand there may be a cost for the requested information. I understand depending on what has been requested, the Balch Springs Police Department may take up to 10 (ten) business days to reply.
The costs for these documents are accessed according to the guidelines set by the General Service Commission of the State of Texas and the City Council of the City of Balch Springs. The following are the costs: 10 cents per page for copies of offense or arrest reports, $6.00 for Accident Reports and $2.50 for Certified Copies plus report cost. When mailing, please include the cost for reports plus a self-addressed stamped envelope.
Open Records request may be made by fax, mail and in person. However a response can only be made with full payment by mail or in person with cash, check or money order. The Balch Springs Police Department Records Division is located at 12500 Elam Road, Balch Springs, TX 75180 or you may call 972-557-6025 or fax 972-557-6027. The lobby hours are 7:30 A.M. to 6:00 P.M. Monday – Friday.
I understand there is information that may not be disclosed because the Balch Springs Police Department complies with Texas State Laws, Texas Government Codes, Open Records and other related laws.
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YOUR SIGNATURE
What information are you requesting? (PLEASE BE SPECIFIC) TO BE: PICKED UP ___ MAILED ___
Type of Report: ______Accident ______Offense ______Arrest
Date of Report: ______Report Number ______
Address where this occurred: ______
Name of Reporting person: ______
Additional Specific information ______
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PUBLIC RECORDS BILLING CHARGES
DATE: ______
PERSON REQUESTING INFORMATION: ______
ADDRESS: ______
PHONE: ______
DESCRIPTION OF INFORMATION: ______
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Number Total
1. Standard-size paper copies: ______@ 10 cents a page $ ______
2. Over-sized paper copies: ______@ 50 cents a page $ ______
3. Personnel Charges: ______@ $15.00/hr $ ______
(1 hr min)
4. Overhead Charges: ______x 20% $ ______
5. Computer Resource Charge ______@ ______$ ______
Hours Cost
6. Postage/Shipping Charges: (Actual Cost) $ ______
7. Certified Records ______@ $2.50 per document $ ______
8. Accident Report ______@ $6.00 $ ______
9. Audio DVD ______@ $5.50 each $ ______
10. Video DVD ______@ $7.50 each $ ______
11. Other charges ______$ ______
TOTAL CHARGES
PAID BY: ______CASH ______CHECK/NO ______MONEY ORDER/NO
RECEIPT NUMBER ______DATE: ______