AKRON CARNEGIE PUBLIC LIBRARY
REQUEST FOR ACCESS TO PUBLIC RECORDS – For viewing purposes only. Please email the Akron Public Library at akronadm@akron.lib.in.us for a Request Form.
Notice: In accordance with Indiana Code § 5-14-3, this form becomes a public record once submitted to the library. Requesters are not required to provide a reason or purpose for their request as a condition of receiving public records.
- REQUESTER INFORMATION
Please print clearly.
| Requester Response | |
| Full Name: | |
| Organization (if applicable): | |
| Mailing Address: | |
| City, State, Zip: | |
| Phone Number: | |
| Email Address: |
- PREFERRED FORMAT & DELIVERY
Please check your preferred method for accessing the records. Fees apply for physical copies as outlined in the library policy.
- Inspection Only: I wish to inspect the records in person at the library at no charge.
- Electronic Copies: Please email the records to the address provided above (Free).
- Physical Copies: Please provide paper copies. I agree to pay the standard copying fees ($0.10/page for black & white; $0.25/page for color).
- I will pick them up in person.
- Please mail them to me. (I agree to pay actual postage/shipping costs in addition to copying fees).
- Additional Information
Select one of the following:
o I am an Indiana resident.
o I am not an Indiana resident.
I am making this request on behalf of (select one of the following):
o Myself
o Another person who is an Indiana resident.
o Another person who is not an Indiana resident.
o An entity that is based in Indiana.
o An entity that is not based in Indiana.
Select one of the following, I am making this request for the following purpose:
o Civil, philanthropic, journalistic, academic, or personal use.
o Commercial use.
o Some other use.
o Prefer not to say.
- DESCRIPTION OF RECORDS REQUESTED
Indiana law requires requests to identify records with reasonable particularity. Please provide specific details, including dates, names, subject matter, and record types (e.g., meeting minutes, financial reports, correspondence) to help staff locate the records efficiently.
- ACKNOWLEDGMENT AND SIGNATURE
By signing below, I acknowledge that I am requesting public records under the Indiana Access to Public Records Act. I understand that the library has a reasonable time to review and produce these records, and that I am responsible for any applicable duplication or mailing fees before the records are released.
Signature of Requester: ______________________________________________
Date: ___________________________
Akron Carnegie Public Library
Mailing Address: P.O. Box 428, Akron, IN 46910
Physical Address: 205 E. Rochester St., Akron, IN 46910
Phone: 574-893-4113 | Fax: 574-893-4113
Email: akronadm@akron.lib.in.us
FOR LIBRARY STAFF USE ONLY — DO NOT WRITE BELOW THIS LINE
| Task / Metric | Staff Action / Documentation |
| Received By (Staff Initials): | |
| Date & Time Received: | / /20___ at : AM / PM |
| Method of Delivery: | [ ] In Person [ ] Mail [ ] Email [ ] Fax |
| 7-Day Acknowledgment Due: | / /20___ (If received via mail, email, or fax) |
| Status of Request: | [ ] Approved [ ] Denied (Attach legal denial letter)
[ ] Partially Approved |
| Total Number of Pages: | Black & White: ________ Color: ________ |
| Total Fees Assessed: | Duplication: $________ + Postage: ________ = **Total:________** |
| Date Paid & Released: | / /20___ |
