Dearborn co public record request, response forms

COUNTY OF DEARBORN, INDIANA Request for Records Pursuant to the Indiana Access to Public Records Act (Indiana Code § 5-14-3-1, et seq., as needed) Please note, this form is not necessary for records maintained by the Dearborn County Clerk of Courts or the Dearborn County Recorder I, _______________________________________, hereby requests that the County of Dearborn, Indiana (the “County”), grant me access to the following records: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (If more space is needed, please attach additional pages to this request form.)

Please provide your Response to this Request in the following manner: Fax:____________________ Email:___________________________________ Mail:_________________________________________________________________________ I am requesting to do the following: □ Inspect the requested records; or □ Be provided with a copy of the requested records.

I hereby acknowledge responsibility for the payment to the County of all reasonable charges incurred by the County to make such information available for inspection and/or copying: Signature:__________________________________

Date:_____________________

Printed Name:_______________________________ ______________________________________________________________________________ THIS SECTION FOR OFFICIAL USE ONLY Received by Auditor’s Office on ___________________________________ Manner in which the Request was received:__________________________________________ Sent to the following Department for response:________________________________________ Response due by:_______________________ (Due in 24 business hours if hand-delivered, due within 7 calendar days if received by fax, mail, or e-mail.)

Enacted by the Dearborn County Board of Commissioners on _____________________

COUNTY OF DEARBORN, INDIANA Response to Request for Records Pursuant to the Indiana Access to Public Records Act (Indiana Code § 5-14-3-1, et seq., as needed) Date Request was received:____________________ Date of Response:____________________ *Please note, if the original Request was hand-delivered, this Response must occur within 24 business hours. If the Request was received by fax, mail, or e-mail, this Response must occur within 7 calendar days.

Name of Responder:_____________________________ Title of Responder:_____________________________ Dear ______________________________: Dearborn County is in receipt of your Request for Records and as required by statute, is providing you with this Response to the same. Please note that the status of your Request is as follows: □ 1.

The following records maintained by Dearborn County will be provided in response to your Request: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ It is estimated that these records will be produced on: ____________________________ □ 2.

The request for the following record(s) is denied because the requested record(s) is(are) confidential or nondisclosable pursuant to Indiana Code §___________________: ________________________________________________________________________ ________________________________________________________________________ Name of Person Responsible for the Nondisclosure:______________________________ Title:_________________________ Phone Number:_________________ Email:________________________ □ 3.

Dearborn County does not have a record responsive to the Request submitted.

□ 4.

Dearborn County may have records responsive to the Request and is in the process of: Enacted by the Dearborn County Board of Commissioners on _____________________

□ (i) □ (ii) □ (iii)

Reviewing our files; Retrieving stored files; or Both items (i) and (ii)

Dearborn County will send you an additional response on or before _________________ to update you on the status of your Request.

Additionally, if you have requested to be provided a copy of the requested records, it is estimated that the copy fee will be $__________. You may pay for the copy fee when you pick up the requested records, however, the requested records will not be provided to you if the copy fee has not been paid in full.

Please note that your Request and any requested records may be reviewed by legal counsel prior to production to ensure that we are not disclosing any records that are deemed confidential and/or nondisclosable pursuant to state statute. If the requested records must be reviewed by legal counsel, we will notify you of the same by an additional response as noted in #4 (above).

All requests that are received, the responses that are generated thereafter, and any records provided will be copied and kept on file in the Auditor’s Office so that Dearborn County has supporting documentation, if it is needed, to prove that the records request was properly responded to.

Date:___________________ Signed:_____________________________ Printed:_____________________________ Title:_______________________________

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Enacted by the Dearborn County Board of Commissioners on _____________________