Travis County Emergency Services District 12

How to Use This Form

This form is used to submit requests for public records maintained by Travis County Emergency Services District 12 (TCESD12). Please provide as much detail as possible about the records you are requesting, including dates, locations, report numbers, or any other identifying information that may help us locate the records.

Once submitted, your request will be reviewed in accordance with applicable public information laws. TCESD12 will determine whether the requested records are available for release, require review or redaction, or are subject to any applicable exceptions.

If additional information is needed to process your request, a member of our team may contact you for clarification. Some requests may require fees for processing, duplication, or other allowable costs. If fees apply, you will be notified of estimated costs before records are prepared and released.

Submitting this form does not guarantee that records will be available for release. Requests are processed based on applicable laws, agency policies, and the availability of responsive records.

Date of Request (required)

First and Last Name of Requesting Party (required)

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Requesting Party Contact Information:

Phone Number (required)

Mailing Address (required)

Email Address (required)

Relationship to the Incident: Please describe your relationship to the incident (e.g., property owner, insurance representative, occupant, involved party, attorney, or family member). (required)

Date of Incident (required)

Approximate Time of Incident (required)

Location of Incident (required)

Explain the Nature of Incident (required)

Incident Record Request Fees (required)

By checking the designated box, I acknowledge and understand that fees may apply for the processing, duplication, and release of requested incident records in accordance with applicable state laws and agency policies. If fees are required, I will be notified of the estimated cost before records are prepared and released. I understand that fees may include allowable charges associated with document retrieval, reproduction, programming, personnel time, or other costs necessary to fulfill the request. Payment must be received prior to the release of records, unless otherwise required by law. I further acknowledge that submission of an Incident Record Request does not guarantee records will be available for release and that requests are subject to applicable public information laws, privacy protections, and any required review or redaction processes. Relationship of the Freedom of Information Act to the Privacy Act - The Freedom of Information Act (FOIA) and the Privacy Act both deal with the disclosure of information held by the Federal Government. The FOIA generally gives the public the right to inspect their government's records but has exemptions which permit the withholding of certain limited classes of records, including records which would cause a clearly unwarranted invasion of personal privacy if disclosed.

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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