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2. City of Jacksonville - Public Records Request
4. All requests must go through the City Recorder first.
6. Name of Requestor
7. Date of Request
9. Requestor's Address
11. City
12. State
13. Zip Code
15. Phone
16. Email Address of Requestor
18. Please describe the records you are requesting and any additional information that will assist us in locating this information for you as quickly as possible. Be sure to include the address of property information is being sought on.
20. Please Note: Staff time will be charged regardless of how information is provided. Copies provided by email are charged at the same rate as hard copies.
22. Method by which I would like to receive the information I have requested:

    1. Review documents at the office by appointment. Charge staff time for collection of records.
    2. Email to me at above address provided. Charge staff time plus duplication costs.
    3. Mail to me at the above address. Charge staff time plus duplication costs and postage.
    4. Call me and I will pick up in person. Charge staff time plus duplication costs.
24. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
26. Electronic Signature
27. Date of Request
    Date of Request
33. Amount due (Copies multiplied by $0.45)
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field