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Contact Information

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Contact Information

*First Name:	*Last Name:	Company (optional)
Street Address	City, State, and Zip Code	Email Address
Phone Numberext.

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Attachments

Attachments

Public Records Request Form

Copy of Driver’s License, passport, or other photographic ID

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Purpose for Inspection/Access to Restricted Records

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Purpose for Inspection/Access to Restricted Records

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Purpose Exemption: If you meet the requirements of one of the following categories, you are exempt from the requirement to provide an access purpose. Please indicate which one of the following exemptions apply and provide the required documentation forming the basis for claiming such exemption as an attachment to this Public Records Request Form: 

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Purpose Exemption: If you meet the requirements of one of the following categories, you are exempt from the requirement to provide an access purpose. Please indicate which one of the following exemptions apply and provide the required documentation forming the basis for claiming such exemption as an attachment to this Public Records Request Form: (Select an Answer) A state, county or city emergency manager. [NRS 239C.220 1(e)(1)] A member or staff person of a terrorism early warning center or fusion intelligence center in Nevada. [NRS 239C.220 1(e)(2)] An employee of any firefighting or law enforcement agency, if the head of the agency has designated the employee as having an operational need to inspect restricted documents. [NRS 239C.220 1(e)(3)] An employee of a public health agency, if the agency is one that would respond to a disaster and if the head of the agency has designated the employee as having an operational need to inspect restricted documents. [NRS 239C.220 1(e)(4)]

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 Agency Head or Designee Contact Information

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Agency Head or Designee Contact Information

Agency Name	Agency Head Designee
Agency Head	Agency Designee Email
Agency Head’s Email	Agency Designee Phoneext.
Agency Head’s Phoneext.

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Restricted Document Inspection Restrictions: a public officer or employee shall observe any person while the person inspects a restricted document in a location and in a manner which ensures that the person does not copy, duplicate or reproduce the restricted document in any way. [NRS 239C.220 (2)]

Copy, Duplication, or Reproduction Exemption: A restricted document will not be copied, duplicated or reproduced unless one of the following conditions apply:

If none of the conditions below apply, you are not permitted to copy, duplicate, or reproduce the records in any way, including photography. You may take notes.

Restricted Document Inspection Restrictions: a public officer or employee shall observe any person while the person inspects a restricted document in a location and in a manner which ensures that the person does not copy, duplicate or reproduce the restricted document in any way. [NRS 239C.220 (2)] Copy, Duplication, or Reproduction Exemption: A restricted document will not be copied, duplicated or reproduced unless one of the following conditions apply: If none of the conditions below apply, you are not permitted to copy, duplicate, or reproduce the records in any way, including photography. You may take notes. (Select an Answer) Upon the lawful order of a court of competent jurisdiction. [NRS 239C.220 3(a)] Note: A certified copy of the court order must be included in the attachments to this access request. As is reasonably necessary in the case of an act of terrorism or other related emergencies. [NRS 239C.220 3(b)] Note: Verifiable documentation establishing whether the requesting party is entitled to this exemption must be included in the attachments to this access request. To protect the rights and obligations of a governmental entity or the public. [NRS 239C.220 3(c)] Note: Verifiable documentation establishing whether the requesting party is entitled to this exemption must be included in the attachments to this access request. A reporter or editorial employee who is employed by or affiliated with a newspaper, press association or commercially operated and federally licensed radio or television station and who uses the restricted document in the course of such employment or affiliation. [NRS 239C.220 3(d)] Note: Verifiable documentation establishing whether the requesting party is entitled to this exemption must be included in the attachments to this access request. Upon the request of a registered architect, licensed contractor, or a designated employee of any such architect or contractor who uses the restricted document in his or her professional capacity. [NRS 239C.220 3(e)] Note: Verifiable documentation establishing whether the requesting party is entitled to this exemption must be included in the attachments to this access request, including the requestor’s contractor or architect license number and identification of the stated need or purpose for the review and copy, including a project name and project owner.

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Certification

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I have read and understand the information above, and upon submission of this form, I certify that the information I have provided is true and correct.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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