Public Records Request Form | Chattanooga-Hamilton County Air Pollution Control Bureau

Public Records Request Form

Name

First

Last

Phone

Address

City

State/Province

Zip/Postal

Is the requestor a Tennessee citizen?

Yes

Please upload your proof of Tennessee citizenship.

Maximum file size: 100MB

Would the requestor like a copy/duplicate of the documentation?

Yes

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:

Delivery Preference

Electronic copy (email must be provided)

USPS First Class Mail

On-site pickup

Review in person

OtherOther

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

Clear

By submitting this form, you agree that your electronic signature is legally binding and has the same legal effect as a handwritten signature.

Date Signed

If you are human, leave this field blank.