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2. Response / Fulfillment Times
   Response or fulfillment by the City of Pacific of this request will occur within 72 hours from the time requested.
4. Date & Time of Request
   Date & Time of Request

   Date & Time of Request
6. Records Being Requested
8. For Inspection Only?

   1. Yes
   2. No
9. Copy of Records Requested?

   1. Yes
   2. No
10. Number of Copies Requested
12. Requested By:
13. Telephone Number
15. Street Address
17. City
18. State
19. Zip
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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