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2. Request for Public Information (Chapter 552, Texas Government Code)

   Submit form to: City Secretary’s Office, 100 S. Monroe Street, Eagle Pass, Texas, 78852 Tel: 830‐773‐1111 Fax: 830‐773‐0595 Email: irodriguez@eaglepasstx.us or earodriguez@eaglepasstx.us

3. Records Request #

   ________________

5. RESPONSE TIME: Chapter 552 requires governmental bodies to respond to requests for public information as promptly as possible; however, please note that some records may be considered confidential and require consultation with legal counsel or may be voluminous/off-site, in which case it may take longer to respond to. If a response will take longer than 10 days for any reason, a notification will be sent to you within such time. Please feel free to discuss your request with our Staff in order to help us provide you with the most accurate and quickest response. CHARGES: Chapter 552 allows governmental bodies to charge for providing public information. Normally, copies will be provided at $0.10 per page; however other charges and/or deposit may apply depending on the type and volume of request. YOUR RIGHTS: For information on your rights under the Public Information Act (PIA), please see our PIA poster located in the City Hall Lobby or access the TX Attorney General Open Government Division webpage: www.oag.state.tx.us. For questions or complaints, please contact the TX Attorney General Open Government Hotline at 1-877-673-6839 (toll free) or (512) 478-6736.

7. I understand that the City of Eagle Pass is under no obligation to create a document to satisfy my request or to comply with a standing request for information. I further understand that the information will be released only in accordance with the Public Information Act, which may require a determination, by the Texas Attorney General prior to release. I further understand that I may review it promptly, and if it cannot be produced within 10 working days the City Secretary's Office will notify me in writing of the reasonable date and time when it will be available. I understand to keep all appointments to inspect records and to pick up copies, failure to keep appointments may result in losing the opportunity to inspect the information at the time requested.

9. Date of Request*
   Date of Request
10. Name of Person or Organization Making Request
12. Address of Person or Organization Making Request*
14. City*
15. State*
16. Zip Code*
18. Email Address
20. Phone Number of Person Making Request*
22. Description of Request*

    Please describe the record(s) you are requesting.

24. Purpose of Request*

    1. Inspect the Record(s)

    1. Receive a Copy/Copies of the Record(s)

    Choose one that describes your intent with the requested records.

26. Number of Copies*

    Identify the number of copies you need

28. 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
30. Signature*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field