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Open Records Request To Inspect Public Records
To the Library Director:
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Date *
MM
/
DD
/
YYYY
I request to inspect and/or receive copies of the following document(s): *
(There is a $0.10 fee for each photocopy received. If the items are to be mailed, the amount of postage will also be charged. If the records are in a non-written format, the charge will be equal to the actual cost of reproduction.)  
Printed Name -- Company Name (if applicable) *
Street Address City, State, Zip Code *
Phone Number -- Fax Number *
E-mail Address *
eSignature *
THIS COMPLETED FORM SHOULD BE SUBMITTED TO THE LIBRARY DIRECTOR.                                                                For Mary Wood Weldon Memorial Library use:
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Total amount charged to applicant to fulfill request: $__________
The request is denied based on the following exemption:
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