PUBLIC RECORDS REQUEST FORM The Tennessee Public Records Act (TPRA) grants Tennessee citizens the right to access open public records that exist at the time of the request. The TPRA does not require records custodians to compile information or create or recreate records that do not exist. To: [Insert Governmental Entity Name and Name and Contact Information for the Public Records Request Coordinator] From: [Insert Requestor’s Name and Contact Information (include an address for any TPRA required written response)] Is the requestor a Tennessee citizen?  Yes  No Request:  Inspection (The TPRA does not permit fees or require a written request for inspection onlyi.)  Copy/Duplicate If costs for copies are assessed, the requestor has a right to receive an estimate. Do you wish to waive your right to an estimate and agree to pay copying and duplication costs in an amount not to exceed $ ? If so, initial here_________________. Delivery preference:  On-Site Pick-Up  USPS First-Class Mail  Electronic  Other: RECORDS REQUESTED: Provide a detailed description of the record(s) requested, including: (1) type of record; (2) timeframe or dates for the records sought; and (3) subject matter or key words related to the records. Under the TPRA, record requests must be sufficiently detailed to enable a governmental entity to identify the specific records sought. As such, your record request must provide enough detail to enable the records custodian responding to the request to identify the specific records you are seeking. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________ _________________________________________ Signature of Requestor and Date Submitted Signature of Public Records Coordinator and Date Received i Note, Tenn. Code Ann. § 10-7-504(a)(20)(C) permits charging for redaction of private records of a utility.

Authority: T.C.A. §§ 10-7-503, 33-1-302, 33-1-303, 33-1-305, and 33-1-309. Administrative History: Original rule filed October 5, 2018; effective January 3, 2019. (This space intentionally left blank.)