Public Records Request Form - City Of Oxford
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1CITY OF OXFORD
107 Courthouse Square
Oxford, MS 38655
662-236-1310
662-232-2337 (fax)
PUBLIC RECORDS REQUEST FORM
Information will be provided within 7 days. Payment is due upon request for information. Please be as specific as
possible to expedite your request. Fill out all entries, sign, and return to the City Clerk’s office in City Hall.
Date of Request: __________________________
Name of Person Requesting Records: _________________________________________________________
Address: ________________________________________________________________________________
Telephone: ______________________ Email: _________________________________________________
1.
Description of Records: _____________________________________________________________
2.
Date of Records: __________________________________________________________________
3.
Department with Custody of Records: _________________________________________________
**Video Footage Requests**
Date of Incident: ____________________ (this date must be within 7 days of current date; the video overwrites
itself every four to seven days, depending on the activity near the camera)
Approximate Time of Incident: _____________________
Location of Incident: _____________________________________________________________________
Other information (nature of the activity in question): __________________________________________
I agree to pay the actual cost of searching, reviewing, duplicating and/or mailing copies of the requested public
records at a cost of not less than fifty cents ($.50) per copy, $7.00 per hour and actual mailing costs. Fees for video
request are: $25.00 per hour and $10.00 per cd/flashdrive.
_________________________________________ ____________________________________________
Printed Name of Person Requesting Records Signature of Person Requesting Records
Clerk’s Acknowledgement
I acknowledge receipt of $_________ from the above individual as payment for the estimated cost of searching,
reviewing, duplicating and/or mailing the requested Public Records.
Date: _______________________________ ____________________________________________
City Clerk/Deputy Clerk
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