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2. First Name*
3. Last Name*
5. Address 1*
7. City*
8. State*
9. Zip*
11. Phone Number*
12. Email Address*
14. Department*

    1. Police

    1. Municipal Court
16. Records*
    Please provide a specific description of the record(s) you desire to receive. Include record title, date, originating city agency/department, or any other pertinent information.
18. Signature of person making the request
20. 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
24. Fees:

    Fees for providing access to public records are authorized by state law and have been established by the city governing body. These fees are set at a level to compensate the city for the actual costs incurred in honoring record requests. You will receive an estimate of the total fees due before payment is required. Payment of all fees associated with any specific record request must be received by the City before any open records may be released to the requestor.

    If you have questions regarding fees, please contact the Muncipal Court/ Police Records Clerk at (316) 744-6000.

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

    This field is not part of the form submission.

28. Submit Submit and Print

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