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<br />e <br /> <br />e <br /> <br />CITY OF LA PORTE <br /> <br />TEXAS PUBUC INFORMATION LAW <br />OPEN RECORDS ACf <br /> <br />Under the Texas PUblic Infonnation Act, the Open Records Act states that anyone may request . <br />information regarding municipal employees and Elected/Appointed. Officials CLeo name, ad~ <br />and telephone number). You have the right to request the exclusion of certain information <br />contained within your personnel files from public access. <br /> <br />You also have a right to change your mind in the future by contacting the Human Resources <br />Department (Elected and Appointed Officials need to return this form to the City Secretary's Office) <br />of the City of La Porte. <br /> <br />Note: All request for disclosure of public information are subject to review of the City Attorney, <br />who shall initially det~ne which information is subject to privacy exclusions pursuant to the <br />Texas Public Information Act. <br /> <br />Do you want to. request that certain information within your personnel file be excluded from public <br />access? <br /> <br />[ ] YES <br /> <br />[~] NO <br /> <br />?~/c~ ~- MeC*be... C. H, F. M . <br />Print Name <br /> <br />~,J.~ <br /> <br />Employee Signatur~ <br />