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* indicates a required field

2. Date of Request*
   Date of Request

   Date of Request

4. First Name
5. Last Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number
14. Fax Number
16. Email Address*
18. Preferred Method of Contact*
    -- Select One --US MailPhoneEmailFax
19. Legal Proceedings*

    Is this request related to a lawsuit in which Lincoln County is a Party, or a tort claims notice filed with the County?

    1. Yes
    2. No
21. Description of Records Requested (please provide as much information as possible)*

    In as much detail as possible, please describe the materials you are requesting: type of document, date, author, title, etc.

23. How do you want to receive the records.*

    Indicate if you want to inspect the records, or if you need physical or digital copies.  Charges may apply for copies.

    1. I only want to inspect the records
    2. I want digital copies if available.
    3. I want printed copies.
25. • The County will respond to your request within a reasonable time.
    • If the estimated costs involved in fulfilling your request exceed $25, the County will advise you of the estimated costs and require your approval before beginning any work.
    • Pre-payment of the estimated costs may be required before taking further action on your request.
    • Full payment of the total amount of costs incurred is required before the public records are inspected or copies are released.

    I HAVE READ AND AGREE TO COMPLY WITH THE ABOVE CONDITIONS, and further agree to pay the cost of fulfilling the Public Records Request according to the conditions set forth above. These costs may include the cost of locating records, reviewing records to redact exempt material, supervising the inspection of records, copying records, certifying records and mailing records.  I agree to pay up to $25 without further approval.

27. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
29. Electronic Signature*
30. Date signed*
    Date signed
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31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit