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Public Records Request Form

2. Date of this request:*
   Date of this request:
4. Requestor's Name
6. Title of record requested (if known):
8. Date of record requested (if known):
   Date of record requested (if known):
9. Location of record requested (if known):
11. Complete description of the record requested:*
13. Indicate the format in which you wish to receive the requested record:

    1. I want to inspect the record (no fee).
    2. I want a digital copy of the record emailed to the address above (no fee).
    3. I want a photocopy of the records (Fee required - see Terms).
    4. I want a photocopy of the records mailed to me. (Fee required - see Terms).
15. Mailing Address (If requesting documents to be mailed)
17. City
18. State
19. Zip Code
21. Phone
22. Email (where digital records are to be emailed to)*
24. Town of Black Mountain
    Town Clerk / PIO
    Public Records Request
    160 Midland Avenue
    Black Mountain, NC 28711
    
    Email the Town Clerk
    
    Fax: 828-669-4204
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field