City of Mingus, Texas

Appendix A — Public Information Request Form

Referenced in Title II – Administration and Government

Instructions

This form is provided in accordance with the Texas Public Information Act (Texas Government Code, Chapter 552). Requests must be submitted in writing and should clearly describe the records sought. Completed forms may be delivered to:

City Secretary
City of Mingus
P.O. Box 115
Mingus, Texas 76463
Email: city@mingus.us

Requester Information

Name
Organization (if applicable)
Mailing Address
Phone
Email

Requested Records

Clearly describe the records or information you are requesting. Please include dates, subjects, departments, or any details that will help locate the records.

Preferred Format

Inspect in person at City Hall
Receive by email (if available electronically)
Receive printed copies (copy fees may apply)
Other (please specify): ________________________

Fee Authorization

Some requests may require payment for copies, labor, or programming time under the Texas Public Information Act. If estimated costs exceed $40, the requester will be notified for confirmation before processing continues.

Maximum amount authorized without notice:

Certification

I understand that this request is made under the Texas Public Information Act, and that certain information may be excepted from disclosure under state law. I agree to pay applicable fees as authorized.

Signature		Date

For City Use Only

Date Received		Received By
Department(s) Notified
Date Completed / Released		Completed By
Fees Charged		Receipt #

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