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Public Records Request

2. Public Records Request
   This form may be used to assist in requesting a public record. Narrowing the scope of the request may help expedite a response. A Records Access Officer will respond to the request in writing within 10 business days from the receipt of the request.

   This form may be used to assist in requesting a public record. Narrowing the scope of the request may help expedite a response. A Records Access Officer will respond to the request in writing within 10 business days from the receipt of the request.

3. Date of Request*

5. First Name*

6. Last Name*

8. Business or Company Name, if applicable

10. Mailing Address*

11. City*

13. State*

14. Zip*

16. Home or Business Phone

17. Cell Phone

19. Email*

21. Describe the type of record(s) requested:

    Please give a detailed description of the type of record(s) requested. Requests for public records shall include a reasonable description of the requested record to the RAO so that he or she can identify and locate it promptly. Narrowing the scope of the request may expedite the response.

23. Select the department that most relates to your request*
    -- Select One --City Clerk's OfficeMayor's OfficeCity Council Finance Division (Asssessor, Auditor, Treasurer/Collector)Department of Public Works Fire Rescue DepartmentPolice DepartmentNorthampton School DepartmentSmith Vocational & Agricultural High SchoolOther

    If you are unsure what department to select or do not see the department you need, please select City Clerk.

25. Preferred method of response
    -- Select One --Paper CopyView or Inspect in City OfficesElectronic Copy

27. Additional information, if necessary

29. Fees
    A RAO shall assess no fee for the first two hours of time spent searching for, compiling, segregating, redacting and reproducing a requested record. A fee shall not be assessed unless such segregation or redaction is required by law or approved by the Supervisor under 950 CMR 32.06(4)(g) and (h). The charge for black and white paper copies or printouts of records of any size susceptible to ordinary means of production shall not exceed $.05 per page, for both single and doubled-sided black and white copies or printouts. If fees are to be assessed, a RAO shall provide a written, itemized, good faith estimate of any fees that may be charged to produce the records prior to complying with the public records request within ten business days.

    A RAO shall assess no fee for the first two hours of time spent searching for, compiling, segregating, redacting and reproducing a requested record. A fee shall not be assessed unless such segregation or redaction is required by law or approved by the Supervisor under 950 CMR 32.06(4)(g) and (h). The charge for black and white paper copies or printouts of records of any size susceptible to ordinary means of production shall not exceed $.05 per page, for both single and doubled-sided black and white copies or printouts. If fees are to be assessed, a RAO shall provide a written, itemized, good faith estimate of any fees that may be charged to produce the records prior to complying with the public records request within ten business days.

31. If you are unable to complete this form
    This particular form is not required to be used when making a request. Requests may be made orally in person to a RAO or custodian or may be written.

    This particular form is not required to be used when making a request. Requests may be made orally in person to a RAO or custodian or may be written.

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit Submit and Print

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