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Public Records Request Form (Form A)City of La Vergne, Tennessee PUBLIC RECORDS REQUEST FORM The Tennessee Public Records Act (TPRA) grants Tennessee citizens the right to access open public records that exist at the time of the request. The TPRA does not require records custodians to compile information or create or recreate records that do not exist. To: Assistant City Recorder (PRRC) - City of La Vergne 5093 Murfreesboro Road, La Vergne, TN 37086 From: ___________________________________ Phone: ____________________________________ Address: ___________________________________ Email: ____________________________________ ___________________________________ Is the requestor a Tennessee Citizen? Yes No Request: Inspection (The TPRA does not permit fees or require a written request for inspection only.1) Copy/Duplicate If costs for copies are assessed, the requestor has a right to receive an estimate. Do you wish to waive your right to an estimate and agree to pay copying and duplication costs in an amount not to exceed $________? If so, initial here: ________. Delivery Preference: On-Site Pick-Up USPS First Class Mail (fees apply) Electronic Other: _________________________ Records Requested: Provide a detailed description of the record(s) requested, including: (1) type of record; (2) timeframe or dates for the records sought; and (3) subject matter or key words related to the records. Under the TPRA, record requests must be sufficiently detailed to enable a governmental entity to identify the specific records sought. As such, your record request must provide enough detail to enable the records custodian responding to the request to identify the specific records you are seeking. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________ _____________________________________________ Signature of Requestor and Date Submitted Signature of PRRC and Date 1 Note, Tenn. Code Ann. § 10-7-504(a)(20)(C) permits charging for redaction of private records of a utility.