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2. Name*
4. Mailing Address*
6. City*
7. State*
8. Zip Code*
10. Email Address*
12. Phone Number*
14. Date of Request*
16. Specific Request for*
18. Is this a video request?
    -- Select One --NoYes

    Meeting recordings, or other video event.
19. Date of Meeting of Video Request
    Date of Meeting of Video Request
20. Name Of Meeting of Video Request
21. How would you like your video file
    -- Select One --URL/Link to downloadDVD

    Select style of delivery
23. The first 50 pages of information is free to the public. Additional pages will be charged at a rate of $.15 per page. Fees will be due at the time of pick up.
25. Signature of Petitioner (This is an electronic signature verifying that you are petitioning the City of Edwardsville for public information)*
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field