Request for Disclosure of Public Records

Date

Requester's Name

First Last

Requester's Address

Street Address Address Line 2 City State ZIP Code

Requester's Phone

I/We (name below) request that Port of Port Orford and its employees (make available for inspection) (provide a copy or copies of) the following records:

Record 1:

Record 2:

I wish to arrange an opportunity to personally inspect the requested records.

Yes

I wish to receive copies of the requested records. A fee of .25 per page copy will be charged.

Yes

Signature

300 Dock Rd
Port Orford, OR 97465

300 Dock Rd

PO Box 490

7:00 am – 3:00 pm M-F

Request for Disclosure of Public Records

Request for Disclosure of Public Records

Commissioners

Port Staff