Form cover
Page 1 of 1

Open Records Request

You may use this digital form to make an official Open Records Request for public records. Open Records Request forms are also available at Baldwin City Hall, located at 803 High Street, Baldwin City, KS.

Requestor Information

Full Name

Address

Phone number

Email address

Records Request Details

Please provide a detailed description of the record(s) requested. Make sure your request is as specific as possible, so that your request may be filled quickly and completely.

Record title

Description of record

Record date or date range

Department the record pertains to

How many copies are you requesting?

ADVISORY:

A list of names and addresses shall not be obtained from public records for the purpose of selling or offering for sale any property or service to the persons listed. This provision pertains to the names and addresses of businesses listed in the public records, as well as the individuals. [K.S.A. 45-220(c)2], K.S.A. 45-230.

Please read and acknowledge each of the following certifications.

I have made a written request for access to and/or copies of certain public records identified above pursuant to the Kansas Open Records Act, and do hereby certify:

1) That I do not intend to and will not use any list of names or addresses contained in or derived from the records or information obtained from the City of Baldwin City for the purpose of selling or offering for sale any property or service to any person on the list or to any person who resides at any address on the list.

1) That I do not intend to and will not use any list of names or addresses contained in or derived from the records or information obtained from the City of Baldwin City for the purpose of selling or offering for sale any property or service to any person on the list or to any person who resides at any address on the list.

2) That I do not intend to and will not give, or otherwise make available, to any person any list of names or addresses contained in or derived from the records or information obtained from the City of Baldwin City for the purpose of allowing that person to sell or offer for sale any property or service to any person on the list or to any person who resides at any address on the list.

2) That I do not intend to and will not give, or otherwise make available, to any person any list of names or addresses contained in or derived from the records or information obtained from the City of Baldwin City for the purpose of allowing that person to sell or offer for sale any property or service to any person on the list or to any person who resides at any address on the list.

3) That I have been informed and am aware that to knowingly sell, give, or receive any list of names or addresses obtained in or derived from public records for the purpose of selling or offering for sale any property or service to persons on the list is a violation of state statute (K.S.A. 45-230) and that any person violating the prohibition shall be liable for payment of a civil penalty.

3) That I have been informed and am aware that to knowingly sell, give, or receive any list of names or addresses obtained in or derived from public records for the purpose of selling or offering for sale any property or service to persons on the list is a violation of state statute (K.S.A. 45-230) and that any person violating the prohibition shall be liable for payment of a civil penalty.

Signature of Requestor

Signature