Yes ____ No ____*
Please note: For a denial, attach a copy of any statement of the reasons denying access to, a copy of, or other information contained in any public record covered by this request. If the request for the record was in writing, the denial determination is subject to review by mandamus under
s. 19.37 (1), Wis. stats., or upon application to the attorney general or a district attorney. (
s. 19.37 (4), Wis. stats.)
Reason for fee:
If a personal record request, the date and name and address of the town employee notified in writing as to the request and response, if any, received from the employee:
Note: See
s. 19.356, Wis. stats.
STATE OF WISCONSIN
Town of ________
________ County
The Town Board of the Town of ________, ________ County, Wisconsin, by this resolution, adopted by a majority of the town board on a roll call vote with a quorum present and voting and proper notice having been given, resolves and orders as follows:
The following fees for satisfying record requests under
s. 19.35, Wis. stats., are established:
The town clerk shall properly post or publish this resolution as required under
s. 60.80, Wis. stats.
Adopted this ______ day of ________, 20__.
[Signatures of town board]
Attest: [Signature of town clerk]
Notes: Copying costs of more than $.25 per page may be subject to legal challenge when the actual costs cannot be demonstrated to be more that $.25 per page.
This form does not establish costs for research or for creating a new record.
Under
s. 19.35 (3) (f), Wis. stats., an authority may require prepayment by a requester of any fees imposed under
s. 19.35 (3), Wis. stats., if the total amount exceeds $5.
STATE OF WISCONSIN
Town of ________
________ County
TO: ________ [Record requester]
Your request for access to the following record of the Town of ________, ________ County, Wisconsin, is granted: [specifically describe record here].
The requested record is subject to the provisions of
s. 19.356, Wis. stats., as the record is [choose Option A, B, or C, as applicable]
(Option A) a record containing information relating to an employee that is created or kept by the Town and that is the result of an investigation into a disciplinary matter involving the employee or possible employment-related violation by the employee of a statute, ordinance, rule, regulation, or policy of the employee's employer.
(Option B) a record obtained by the Town through a subpoena or search warrant.
(Option C) a record prepared by an employer other than the Town that contains information relating to an employee of that employer, unless the employee authorizes the Town to provide access to that information.
Under
s. 19.356, Wis. stats., all of the following conditions apply to the grant of access to the requested records:
1. Within 3 days after making the decision to permit access, the Town will serve written notice of that decision on any record subject to whom the record pertains.
2. Within 5 days after receipt of the notice under paragraph 1, the record subject may provide written notification to the Town of his or her intent to seek a court order restraining the Town from providing access to the requested records.
3. Within 10 days after receipt of the notice under paragraph 1, the record subject may commence an action seeking a court order to restrain the Town from providing access to the requested record. If the record subject commences such an action, you may intervene in the action as a matter of right. If you do not intervene in the action, the Town will notify you of the results of the proceedings in the action.
4. The Town will not provide access to the requested record within 12 days of sending the notice under paragraph 1. In addition, if the record subject commences an action as described in paragraph 3, the Town will not provide access to the requested record during the pendency of the action. If the record subject appeals or petitions for review of a decision of the court or the time for appeal or petition for review of a decision adverse to the record subject has not expired, the Town will not provide access to the requested record until whichever of the following occurs first:
a. Any appeal is decided.
b. The period for appealing or petitioning for review expires.
c. A petition for review is denied.
d. The Town receives written notice from the record subject that an appeal or petition for review will not be filed.
Dated this ______ day of ________, 20__.
[Signature of town clerk (or other record custodian)]
Note: Whenever a record request relates to an employee record, a determination must be made whether the record is of the type described in
s. 19.356 (2) (a) 1.,
2., or
3., Wis. stats., in which case, if the request is granted, notice must be given to the record subject and access cannot be provided to the record except as provided in
s. 19.356, Wis. stats., or if the record is of the type described in
s. 19.36 (10) or
(11), Wis. stats., in which case access must be denied.
If the record is not subject to
s. 19.356 (2) (a) 1.,
2., or
3., or
19.36 (10) or
(11), Wis. stats., but the record subject is a state or local elected official, the request is subject to
s. 19.356 (9), Wis. stats., and notice must be given to the record subject who is entitled to augment the record within 5 days of receipt of the notice. See the forms:
“Record subject” is defined in
s. 19.32 (2g), Wis. stats., as:
19.32 (2g) “Record subject” means an individual about whom personally identifiable information is contained in a record.
STATE OF WISCONSIN
Town of ________
________ County
TO: ________ [Record subject]
A request for access to the following record of the Town of ________, ________ County, Wisconsin, has been granted by the Town: [specifically describe record here].
You are the subject of the requested record.
The requested record is subject to the provisions of
s. 19.356, Wis. stats., as the record is [choose Option A, B, or C, as applicable]
(Option A) a record containing information relating to an employee that is created or kept by the Town and that is the result of an investigation into a disciplinary matter involving the employee or possible employment-related violation by the employee of a statute, ordinance, rule, regulation, or policy of the employee's employer.
(Option B) a record obtained by the Town through a subpoena or search warrant.
(Option C) a record prepared by an employer other than the Town that contains information relating to an employee of that employer, unless the employee authorizes the Town to provide access to that information.
Under
s. 19.356, Wis. stats., all of the following conditions apply to the grant of access to the requested record:
1. Within 5 days after receipt of this notice, you may provide written notification to the Town of your intent to seek a court order restraining the Town from providing access to the requested record.
2. Within 10 days after receipt of this notice, you may commence an action seeking a court order to restrain the Town from providing access to the requested record. If you commence such an action, the record requester may intervene in the action as a matter of right.
3. The Town will not provide access to the requested record to the record requester within 12 days of sending this notice. In addition, if you commence an action as described in paragraph 2, the Town will not provide access to the requested record during the pendency of the action. If you appeal or petition for review of the decision of the court or the time for appeal or petition for review of a decision adverse to the record subject has not expired, the Town will not provide access to the requested record until whichever of the following occurs first:
a. Any appeal is decided.
b. The period for appealing or petitioning for review expires.
c. A petition for review is denied.
d. The Town receives written notice from you that an appeal or petition for review will not be filed.
Dated this ______ day of ________, 20__.
[Signature of town clerk (or other record custodian)]
Note:
Section 19.356 (2) (a), Wis. stats., provides that the Town shall “within 3 days after making the decision to permit access, serve written notice of that decision on any record subject to whom the record pertains, either by certified mail or by personally serving the notice on the record subject.”
STATE OF WISCONSIN
Town of ________
________ County
TO: ________ [Record requester]
Your request for access to the following record of the Town of ________, ________ County, Wisconsin, is granted: [specifically describe record here].
The subject of the requested record holds a [state or local] public office, namely ________.
Under
s. 19.356 (9), Wis. stats., all of the following conditions apply to the grant of access to the requested record:
1. Within 3 days after making the decision to permit access, the Town will serve written notice of that decision on any record subject to whom the record pertains.
2. Within 5 days after receipt of the notice under paragraph 1, the record subject may augment the record to be released with written comments and documentation selected by the record subject.
3. The Town will release the requested record, as augmented by the record subject, upon the expiration of the 5-day period for augmenting the record under paragraph 2.
Dated this ______ day of ________, 20__.
[Signature of town clerk (or other record custodian)]
Note: “Local public office” is defined in
s. 19.32 (1dm), Wis. stats., as:
19.32 (1dm) “Local public office” has the meaning given in
s. 19.42 (7w), and also includes any appointive office or position of a local governmental unit in which an individual serves as the head of a department, agency, or division of the local governmental unit, but does not include any office or position filled by a municipal employee, as defined in
s. 111.70 (1) (i).
And “local public office” is defined in
s. 19.42 (7w), Wis. stats., as:
19.42 (7w) “Local public office” means any of the following offices, except an office specified in sub. (13):
(a) An elective office of a local governmental unit.
(b) A county administrator or administrative coordinator or a city or village manager.
(c) An appointive office or position of a local governmental unit in which an individual serves for a specified term, except a position limited to the exercise of ministerial action or a position filled by an independent contractor.
(cm) The position of member of the board of directors of a local exposition district under subchapter II of chapter 229 not serving for a specified term.
(d) An appointive office or position of a local government which is filled by the governing body of the local government or the executive or administrative head of the local government and in which the incumbent serves at the pleasure of the appointing authority, except a clerical position, a position limited to the exercise of ministerial action or a position filled by an independent contractor.
“State public office” is defined in
s. 19.32 (4), Wis. stats., as:
19.32 (4) “State public office” has the meaning given in s.
19.42 (13), but does not include a position identified in s.
20.923 (6) (f) to
(gm).
“Record subject” is defined in
s. 19.32 (2g), Wis. stats., as:
19.32 (2g) “Record subject” means an individual about whom personally identifiable information is contained in a record.
STATE OF WISCONSIN
Town of ________
________ County
TO: ________ [Record subject]
A request for access to the following record of the Town of ________, ________ County, Wisconsin, has been granted by the Town: [specifically describe record here].