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City of Burley PO Box 1090 Burley, Idaho 83318 [PHONE REDACTED] Public Records Request Form Date of Request Name _ Address City _ State Zip Code Telephone Email Address As set forth in Idaho Statues Title 74 Chapter 1, I acknowledge by my signature that the records sought by this request will not be used for a mailing list or telephone number list. No fee will be charged for the first two hours of labor or for copying the first 100 pages. Thereafter, a charge of $20.00 per hour and $0.05 per copy will be payable before the request is filled. Signature Please be specific so it can be determined what records need to be provided. I hereby request to examine and/or copy the following public records: Information delivered by: Email Fax Mail Service Requestor Pick Up Date Received Date Completed Fees Collected Receipt No. SIGN