Public Records Request Form – St. Lucie West Services District (SLWSD)
Most requests for public records will be processed within five (5) working days of receipt in the District Manager’s office. You will be notified in writing either by fax, email, or letter as to when your request can be completed and timeframe to be completed. Sufficient time must be granted to the District Manager’s office to collect the necessary documents. A deposit may be required at time of request.
Name: _______________________________	Company: ______________________________ Address: __________________________________	City: ____________________________________ State: ____________________________________	Zip Code: ________________________________ Phone: ___________________________________	Fax: _____________________________________ Email Address:  		
What public record are you requesting?
Give as much specific details as possible, the type of document, category or action taken, date or time frame.

Date needed: (mm/dd/yy)  	

Cost for records requests: Single sided page $.15 per page Double sided page $.20 per page
$1 per certified copy
CDs request are submitted to District Clerk and are $10.00/each
Section 119.07 (4) (a) and (c), Florida Statutes

How would you like to receive the information?	  Pick-up     Mail    Fax	 Email
Certain public records requests may incur extra costs for administrative tasks, such as requests requiring research or other types of extra involvement to obtain the request.
Payment is due at completion and may require deposit before staff will perform any records research or document copying according to Chapter A-1.04 of St. Lucie West Services District General and Procedural Rules. Checks or money orders should be made payable to St. Lucie West Services District.
Please submit request to St. Lucie West Services District
450 SW Utility Drive Port St. Lucie, FL 34986
*Please initial here to show you have read and understand all information above. ______

STAFF USE ONLY	Initials of Staff: ___________	# of copies ____________	Single sided	Double sided	

Dept: ____________	
Code(s): ___________________			
STAFF NOTES:	

Revised July 2013	*Signature or completion of form is not required