City of Victoria Form Center

2. Name
3. Company Name
   If applicable
5. Today's Date
   Today's Date
   Date of Request
6. How would you like to receive the information you are requesting?

   1. U.S. Mail
   2. Email
   3. Pick-up in Person
8. If you would like the information you are requesting to be sent to you via U.S. Mail, please enter your mailing address:
10. State
11. City
12. Zip Code
14. Email Address
    If you would like the information you are requesting to be sent to you by email, please enter your email address.
15. Daytime Phone
19. Describe in detail the information you are requesting, including dates and locations.
    Please note, if you are requesting information relating to a person, you must include a date of birth or other identifying information.
21. Are you requesting information about yourself?

    1. Yes
    2. No
    3. Not Applicable
22. If you answered no to the previous question, please describe your relationship to the person who is named in your request.
24. Important Notice
    The information you have requested may be subject to one or more applicable exceptions to the Texas Public Information Act. Original documents may not be removed from City Offices.
26. Charges may apply.
    Texas Attorney General
28. Expedited Delivery
    You may choose to amend your request to avoid submission to the Texas Attorney General. If you select this option, you agree that the City may redact any information considered by statute or otherwise to be privileged or non-releasable pursuant to the Texas Public Information Act.
30. I hereby amend my request and agree that the City may redact the information I have requested according to any applicable exceptions to the Texas Public Information Act.

    1. Yes
31. Enter Your Initials
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field