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2. First Name (optional)
3. Last Name (optional)
5. Address (optional)
7. City (optional)
8. State (optional)
9. Zip (optional)
11. Requestor Contact Information is Optional

    If you have not provided a Phone Number, Mailing Address, or E-Mail with this request, the City will not be able to contact you about your request.

    Please call the City Clerk's Office at 321 868-3235 for the status of your records request.

13. Phone Number (optional)
14. E-Mail (optional)
16. Date Range of Records Request (e.g. 11-12-13 - 07-12-14)*
18. Date Range for Records Request
    Date Range for Records Request Start Date

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    Date Range for Records Request End Date
20. Records Request - Please provide as much detail as possible about the record(s) being requested *
22. If requesting e-mail addresses, list names to be included
24. Provide terms to search for, to be used for e-mail and electronic records search (such as: "Name", "Topic")
26. Are you aware of any litigation related to the records request?

    1. Yes
    2. No
28. Contact Information Requirements*

    If you have not provided your Phone Number, Address, or E-Mail with this request, the City has no way of contacting you. Please call the City Clerk's Office at 321 868-3235 to check on the status of your records request. 

    The City Clerk is the Records Custodian for City records. 

    City Clerk
    1600 Minutemen Causeway
    P.O. Box 322430,
    Cocoa Beach, Fl. 32932

    E-mail: cityclerk@cityofcocoabeach.com

    1. I read the Contact Information Requirements
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30. 1. Receive an email copy of this form.
31. Email address

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