Form Center

2. REQUEST PURSUANT TO THE KANSAS OPEN RECORDS ACT
   (Read Carefully Before Signing) “No person shall knowingly sell, give or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in or derived from public records...” K.S.A. 45 Violation of this law may subject the violator to a civil penalty of $500.00 for each violation. By signing below, I acknowledge that I am aware of and understand K.S.A. 45-230. Pursuant to Kansas Open Records Act, I request the following records. (Please specify):
6. Please state the request here:*
10. I would like the records...*

    1. Electronically
    2. On Paper
12. Requester's Name*
13. Requester's Address*
15. Requester's Phone Number:*
16. Date of Submittal*
18. Requester's Email Address*
20. Type your full name below if you have read and agree to obide by all conditions stated on this form:*
22. By signing this request form, the requester makes the following certification pursuant to K.S.A. 45-220(c)(2): “The requester does not intent to, and will not: (A) Use any list of names or addresses contained in or derived from the records or information for the purpose of selling or offering for sale any property or service to any person listed or to any person listed or to any person who resides at any address listed; or (B) sell, give or otherwise make available to any person 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"
Leave This Blank:


24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

* indicates a required field