Public Service Request Form (Historic)
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Public Service Request Form (Historic)
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PSR
PUBLIC SERVICE REQUEST
Name
Address
City, State, Zip
Telephone
Cost for Data requested
A. Research Charge: $______/hour (less than 5 minutes are free)
B. Copies: .10/copy Letter
C. Tape or video recording: $1.50 per tape.
D. CD: $10.00 per CD. (Labor is included.)
Detailed Explanation of data requested:
X
Signature Date of request
*************************for office use***************************
Date Completed: By:
Total Cost: $ Date Paid: Rec’d by:
Treasurer’s Office Receipt #:
Taney County Courthouse Annex, PO Box 156, 139 David St, Forsyth, MO 65653
Revised 03/27/07
Public Service Request Form (Historic)
The original county PDF remains the downloadable record artifact and the printable source document.