Open Records Request

COMMUNITY AND DEVELOPMENT SERVICES (CDS) REQUEST FOR REPRODUCTIONS OF PUBLIC RECORDS

Commercial requests must be notarized and are therefore not fillable online. Please print the PDF instead. Contact tboggess@comdev-services.com for more information. If all or any part of the records requested will be used directly or indirectly for sale, resale; solicitation, rent or lease of a service, or any use by which the user expects a profit either through commission, salary, or fee, then the request is deemed commercial. Applicant requesting a public record for commercial purpose shall provide a certified statement with this request stating the commercial purpose for which it shall be used.

1. GENERAL RECORDS REQUEST

1. Applicant Information - All sections are to be completed by Applicant.

APPLICANT NAME:*

First Last

FIRM NAME:

ADDRESS:*

Street Address Address Line 2 City State ZIP Code

PHONE:*

FAX:

2. Records Requested - Please describe the records being requested.*

Is request for a record in an electronic format?*

Yes
No
Don’t Know - to be determined by CDS

3. Purpose of request for public records. Also Check Box A, B,C or D.

Complete this section if you are obtaining the records for a Client.

FIRM/AGENCY:

CONTACT:

ADDRESS:

Street Address Address Line 2 City State ZIP Code

PHONE:

FAX:

A. COMMERCIAL - All or any part of the records requested will be used directly or indirectly for sale, resale; solicitation, rent or lease of a service, or any use by which the user expects a profit either through commission, salary, or fee. Applicant requesting a public record for commercial purpose shall provide a certified statement with this request stating the commercial purpose for which it shall be used. Applicant’s signature must be notarized. (Go to Section II, No. 1.)
B. EXEMPTION FROM COMMERCIAL PURPOSE - Records requested shall be used for publication, broadcast, or other related use of a public record by a newspaper or periodical or use of a public record by a radio or television station in its news or other information programs. Applicant’s signature must be notarized. (Go to Section II.)
C. EXEMPTION FROM COMMERCIAL PURPOSE - Records requested shall be used in the preparation for prosecution or defense of litigation, or claims settlement by the parties to such action, or attorneys representing the parties per Case and Action Number
D. EXEMPTION FOR NON-COMMERCIAL PURPOSE - All or any part of the records requested will not be used directly or indirectly for sale; resale; solicitation; sale , rent; or lease of a service or any commercial venture. (go to Section II.)

Case and Action Number*

(go to Section II.)

THE APPLICANT WHO OBTAINS PUBLIC RECORDS AND FAILS TO COMPLY WITH KRS CHAPTER 61 WILL BE LIABLE TO HCCPC FOR THE DAMAGES EQUAL TO THREE TIMES THE AMOUNT THAT WOULD HAVE BEEN CHARGED FOR THE PUBLIC RECORD IF THE ACTUAL COMMERCIAL PURPOSE FOR WHICH IT HAS BEEN OBTAINED OR USED HAD BEEN STATED, COSTS AND REASONABLE ATTORNEY’S FEES AND ANY OTHER PENALTY ESTABLISHED BY LAW.

You have selected "Commercial Request". Commerical requests cannot be made online as they have to be notarized. Please print and fill out the paper form and have it notarized before sending it to us.

IV. RETURN ADDRESS
Completed request Form Should Be Returned To:

Geographic Information Systems or Related Digital Data/information:

GIS Department
Community and Development Services
710 S. Main St.
P.O. Box 1125
Hopkinsville, KY 42241-1125
FAX 270-887-4019

For Other Requests:

Office Manager
Community and Development Services
710 S. Main St.
P.O. Box 1125
Hopkinsville, KY 42241-1125
FAX 270-887-4019

2. APPLICANT’S CERTIFIED STATEMENT

Non-Commercial Request
I,

(Print Name)*

, do hereby certify that the records requested will be used for a non-commercial purpose as described in Section 1. No. 3.

Signature*

IV. RETURN ADDRESS
Completed request Form Should Be Returned To:

Geographic Information Systems or Related Digital Data/information:

GIS Department
Community and Development Services
710 S. Main St.
P.O. Box 1125
Hopkinsville, KY 42241-1125
FAX 270-887-4019

For Other Requests:

Office Manager
Community and Development Services
710 S. Main St.
P.O. Box 1125
Hopkinsville, KY 42241-1125
FAX 270-887-4019

Comments

This field is for validation purposes and should be left unchanged.

COMMUNITY AND DEVELOPMENT SERVICES (CDS) REQUEST FOR REPRODUCTIONS OF PUBLIC RECORDS

1. GENERAL RECORDS REQUEST

2. APPLICANT’S CERTIFIED STATEMENT

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