2. Note:
   You are not required to give your name and address. It is requested only to the extent necessary to contact you when the records are ready for you or to mail them to you.
4. Name of Individual Requesting Records (Optional)
6. Street Address
8. Apt, Suite, Bldg. (Optional)
10. City
11. State / Province / Region
13. Postal / Zip Code
14. Country
16. Phone*
17. Email
19. I am requesting the following records:*
    Please be specific.
21. Pursuant to Wisconsin Statute §19.35(3), a location fee may be charged. In addition, duplication and shipping/handling fees may also be charged for this request. Duplication fees are $0.25 per page, and prepayment is required if the total fee exceeds $5.00.
23. Please choose how you wish to receive the requested records: *

    1. View/Inspect the records only (possible location fee)
    2. Have copies made and pick up (possible location fee, duplication fee)
    3. Have responsive records mailed or e-mailed (possible location fee, duplication fee, possible postage fee)
25. When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account, or to process the payment as a check transaction. Checks should be payable to the “City of Green Bay”.
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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

* indicates a required field