Banner
Go To Search
TwitterFacebookHome
Open Record Information

REQUEST FORM FOR COPIES OF OPEN RECORDS

 

 

(To be completed by Requester)

 

NAME:

 

 

ADDRESS:

 

 

 

RECORD(S) SOUGHT:

 

________________________________________________________________________

 

 

 

CERTIFICATE OF COMPLIANCE WITH

K.S.A. 21-3914 & K.S.A. 45-220©

 

I,______________________________________, understand that no person shall receive, for the purposes of selling or offering for sale any property or service to person listed therein, any list of names or addresses contained in or derived from a public record.

 

I also understand that violation of the statute prohibiting the unlawful use of names derived from a public record is a Class C Misdemeanor.

 

In accordance with these provisions, I certify that I do not intend to, and will not, use any list of names or addresses contained in or derived from public records for the purpose of selling or offering for sale any property or service to any person listed or to any person who resides at any address listed; neither will I sell, give, or otherwise make available to any person any list any list of names or addresses contained in or derived from the records or information for the purpose of allowing that person to sell or offer for sale any property or service to any person listed or to any person who resides at any address listed, except under authority of the limited circumstances provided in K.S.A. 21-3914

 

 

                                                                                 

______________________________

Signature

 

 

______________________________

Name(please type or print)

 

______________________________

Date