CITY SECRETARY
5024 Broadway Ave., Haltom City, TX 76117

Request for Information

In making this request I understand that the City is under no obligation to create a document to satisfy my request or to comply with a standing request for information. I further understand that the information will be released only in accordance with the Public Information Act, which may require a determination as to confidentiality by the Texas Attorney General prior to a release. I further understand that the City has ten (10) business days in which to request such a determination.

Date of Request:				Email:
Name:				Phone #:
				Fax #:

Address:
Street	City	State	Zip Code

Pursuant to the Public Information Act, Texas Government Code, Section 552, I hereby request the following information currently existing in the records of the City of Haltom City, Texas (Please be as specific as possible with your request and know that a fee may be charged for the information):
How would you like to view this material:
Will pick up at City Hall (fee may apply)
Will view at City Hall
Other - please explain: