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2. 

3. CITY OF PORTAGE, INDIANA

   Records Request Pursuant to Indiana Access to Public Records Act

   (I.C. 5-14-3-1, et seq., as amended)

5. I hereby request of the City of Portage, Porter County Indiana, the right to inspect the following records:

6. Date:
   Date:
8. Please list document here:*
10. The City may provide me with its response to this request by:*

    1. Telephone (for informal response) and/or:
    2. By facsimile transmission

    1. By mail
    2. By email

    1. Other
14. Name*
15. Email Address*
17. Business/Department Name or N/A
19. Address*
21. City*
22. State*
23. Zip Code*
25. Phone Number
26. Fax Number
28. Printed employee name/department receiving request
30. Employee Signature
31. Date/time received
33. Disclaimer

    Response(s) will come from mwalbright@portage-in.com An initial response will come within 5 business days.

35. Approved/Not Approved

    1. Approved for release

    1. NOT approved for release (see attached)
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field