Assessor's Public Records Request Form

ADA COUNTY ASSESSOR'S OFFICE
190 E. Front Street, Suite 107 Boise, Idaho 83702
Phone: 208 287-7200 • Fax: 208 287-7209
Note: Idaho Code § 74-113, 115 & 120 permit Ada County to verify requestor's identity for the purpose of: Protecting personal information in compliance with state and federal law, and to ensure this information is NOT for purposes such as mailing/solicitation list or to supplant a discovery procedure.
Name*
Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Address*
Street Address City State ZIP Code
Phone*
Fax
Email*
Preferred Delivery Method*
- E-Mail
- Pick Up In Person
(Please note that e-mail is generally the most cost-effective method for delivering documents. Requests for large amounts of data may require that data be placed on CD or a similar data medium, resulting in fees as outlined below. Delivery by e-mail may eliminate per page copying fees, however, will not eliminate fees charged for staff time if applicable. Fees must be paid in advance, including staff processing time if estimated at greater than two (2) hours.)
Description of Requested Information (Note: Please be specific, this may help reduce request completion time):*
Requestor's Signature (Please type your name)*
CAPTCHA

All emails sent to County officials are public records and may have to be disclosed in response to requests for public records, including names, addresses, phone numbers and e-mail addresses.

FOR INTERNAL USE ONLY

Request Receipt & Department Review:

Request Completion:

Copy & Staff Work Time Fees


Request Recipient	Date

Reviewer	Date

Reviewer	Date

Reviewer	Date

Note: Some departments may choose to have multiple reviewers

Request Completed By

______/______/________

Date Completed

______/______/________

Date Requestor Contacted

Notification by:	❑	❑	❑
	Mail	Phone	EMail

______/______/________

Date Request Picked Up or Sent

Pursuit to I.C. § 74-102(10) & Ada County
Resolution #1933 & 1946______ x $.01 / $.06 = $___________
# Pages Copied > 100 (1 ¢ b/w; 6¢ color) Fee

Records larger than 8.5″x14″: $0.15 per sq. ft gray & white; $2.25 per sq. ft. color.
Alternate medium: Required or requested use of a data medium such as a CD or thumb drive, will require a charge equal to the cost of such medium (first $5.00 waived).

$	x	$
Cost of CD/USB/Other	Quantity	Fee

$______________ / per hour
Hourly Rate of Staff Completing Request (First two (2) Hours are FREE of charge)

$	x	$
# Hours Worked	Rate	Fee

$________________
Total Cost

Notes: