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Request For Record Inspection Or For Copy - Kansas

Request For Record Inspection Or For Copy Form. This is a Kansas form and can be used in Open Records 4th Judicial District Local District Court .
 Fillable pdf Last Modified 4/30/2009
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REQUEST FOR RECORD INSPECTION OR FOR A COPY (The section below is to be completed by person making the request) Date: Name: Address: Daytime Phone: Fax: ___________________________________ I certify that I do not intend to, and will not: (1) Use any list of names or addresses contained inor derived from the records or information requested for the purpose of selling or offering for saleany property or service to any person listed or to any person who resides at any address listed; or(2) sell, give, or otherwise make available to any person any list of names or addresses containedin or derived from the records or information for the purpose of allowing that person to sell oroffer for sale any property or service to any person listed or to any person who resides at anyaddress listed. See K.S.A. 21-3914. Signature: __________________________________________________________________ RECORD SOUGHT: Please provide as specific a description as possible of the records you desireto inspect or for which you request a copy. Include records titles and dates as well as the name ofthe court which holds the record. Description of Record # of copies desired1. ________________________________________________________________________ 2. ________________________________________________________________________ 3. ________________________________________________________________________ CHARGES: A charge for providing access to public records is authorized by state law and hasbeen established by the Kansas Supreme Court. Charges are set to compensate for the actualcosts in honoring your request. The fee schedule established for this Judicial District is posted inthe office of the Clerk of the District Court. The charge for access to and/or copies of therecord(s) you have requested is estimated to be $ ___________________. Prepayment of the above amount may be required. <<<<<<<<<********>>>>>>>>>>>>> 2(The section below is to be completed by the Record Custodian) Time of request: ________________________________________________________________ (Date) (Time) (Person receiving request)Records Provided or Denied: ______________________________________________________ (Date) (Time) (Person providing record or denial) Staff time involved: ___ hours, ___ minutes, for a charge of $ _________________________. Charge for copies made: $ ___________________ Total Charges: $ ___________________ Estimated payment received$ ___________________ Amount remaining due $ ___________________ (or) Amount refunded $ ___________________ ______________________________________ Record Custodian (9/00)
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