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2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Email Address
15. Telephone
17. Date of Request
    Date of Request

    Date of Request
18. I am requesting the following records (please be very specific):
20. ASSOCIATED COSTS
    Cost of copies ($0.15 single-sided and $.20 double- sided) Certified copies ($0.15 single-sided + $1 set) Copies of Commission Meeting DVD ($0.30 each) Copies of Commission Workshop CD’s ($0.25 each) **Costs are only projected. Additional monies may be due upon actual receipt of documents.
22. I Understand that this Request is associated with a cost and will not be fulfilled until payment is received by the City Clerk's Office located at 4300 NW 36th Street, Lauderdale Lakes, FL 33309*

    1. yes
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit Submit and Print

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