Request for Public Records Form
P.O.
Box 987, Chesterfield, MO 63006
636-227-8607
Phone, 636-227-1914 Fax
www.clarksonvalley.org,
cvcityhall@sbcglobal.net
Date
of Request: ______________________________________________
Time
of Request: ______________________________________________
Name
of Person making Request: _________________________________
Where
person making request can be located: _______________________
Public
record(s) being requested: _________________________________
_____________________________________________________________
_____________________________________________________________
Signature
of person making request:
--------------------------------------------------------------------------------------------
To
be completed by Michele McMahon, Custodian of Records
Estimated
cost for document search and duplication: __________________