City Clerk

2. First Name*
3. Last Name*
5. Address*
7. City*
8. State*
   -- Select One --AL - Alabama AK - Alaska AZ - ArizonaAR- ArkansasCA - CaliforniaCO - Colorado CT - Connecticut DC - District of ColumbiaDE - Delaware FL - FloridaGA - GeorgiaHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA- IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganMN - MinnesotaMS - MississippiMO - MissouriMT - MontanaNE - NebraskaNV - NevadaNH - New Hampshire NJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonPA - PennsylvaniaRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - Tennessee TX - TexasUT - UtahVT - VermontVA - VirginiaWA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming
9. Zip Code*
11. Phone Number*
12. Email Address*
14. Type of Request*

    1. Inspection only
    2. Copying Only
    3. Inspection and Copying
16. Record Title, Date, Number and/or Description*
18. Number of Copies*
19. Requesting Certified Copy?*

    1. Yes
    2. No
21. Record Title, Date, Number and/or Description
23. Number of Copies
24. Requesting Certified Copy?*

    1. Yes
    2. No
26. Record Title, Date, Number and/or Description
28. Number of Copies
29. Requesting Certified Copy?*

    1. Yes
    2. No
31. Is this a Commercial Request?*

    1. Yes
    2. No
32. Relationship to Party Involved*
    -- Select One --SelfSpouseParentOther
34. Name of the Party Involved?*
35. Please Describe the Relationship. *
37. Fees

    Fee Type	Cost
    Cost per page	$0.25
    Certified Copy Cost per Page	$1.00
    Copies on Compact Disc, D.V.D. or Flash Drive	$5.00
    Returned Check Fee	$20.00

39. Notice to Applicant

    I swear under penalties of perjury, that any accident report or related investigation is not being requested, examined, reproduced or otherwise to be used for commercial solicitation.
    
    Mechanical reproduction, where possible, of certain items not readily able to be photocopied will be charged on an estimated basis to cover such costs as determined by the City Manager. A search fee shall be charged to compile records. A fee will also be charged equivalent to the rate of supervision required. If the estimated costs to be charged hereunder exceed $10.00, prepayment shall be made and final accounting of any sums due and payment therefore shall be made prior to delivery. Please take notice that certain records are not open to public inspections or copying pursuant to exemptions granted by federal and state law. If your request is denied in whole or in part, you may give written notice to the City Manager requesting review of the denial. All fees are due at the time the request is fulfilled and are non-refundable. 

41. I Acknowledge and Agree to the notice of Applicant Above. *

    1. Yes
43. I swear under penalties of perjury, that any accident report or related investigation is not being requested, examined, reproduced or otherwise to be used for commercial solicitation.*

    1. I Acknowledge & Agree to the Statement Above.
45. Electronic Signature*

    (Full Legal Name Required) *Falsifying this Electronic Signature will be prosecuted by the City of Bixby with the appropriate court

47. Staff Fee Calculation

    Fee type	Fee	Copies	Total
    Copy Charge	$0.25
    Certified Copy	$1.00
    CD, DVD, Flash Drive	$5.00
    Search Fee

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49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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