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2. Name*
3. Email Address*
5. Address
6. City
8. State
9. Zip Code
10. Phone Number*
12. From which department are you requesting records?*

    1. Administration Services
    2. Dispatch
    3. Finance
    4. Human Resources
    5. Operations
    6. Other
13. If other, please specify:
15. Request *

    Please provide a detailed description of identifiable records. The more specific your request, the more quickly we can process and deliver responsive records.

17. Note: You will be contacted when the files and/or copies you requested are available. Jefferson Transit may need up to five business days to complete your request or to provide a date by which the records will be available. Public records not exempt from the Public Records Act are available for copying. Black and white copies for most documents can be made by Jefferson Transit for a fee of $0.15 per page. Copies of non-standard format records, such as videotapes, audiotapes, color copies, blueprints, etc. can be made by Jefferson Transit for the actual cost of such copies. This request for a copy of Public Records will be maintained as a portion of the Public Record. Allowing the inspection and copying of public records by Jefferson Transit is not meant to waive or restrict any copyright, proprietary, or other rights in said documents.

19. Delivery

    1. Digital Records
    2. Paper Copies [mailed to address listed above]
    3. Paper Copies [will pick up at JTA office]
    4. In-person inspection

20. You many receive electronic copies of the requested records when available. Records not available in electronic format will be mailed to you.

    Inspect the records requested in person at JTA offices during regular business hours. At time of inspection you can make requests for paper copies of documents you select.

22. Requester Signature*
23. Date*
    Date
Leave This Blank:


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

    This field is not part of the form submission.

27. Submit

* indicates a required field