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<br />e <br /> <br />e <br /> <br />CITY OF LAPORTE <br /> <br />TEXAS PUBLIC INFORMATION LAW <br />OPEN RECORDS ACf <br /> <br />Under the Texas PUblic Information Act, the Open Records Act states that anyone may request <br />infonnation regarding municipal employees and Elected/Appointed Officials (ie. name, address, <br />and telephone number). You have the right to request the exclusioQ. 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 fonn 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 reviifiW of the City Attorney, <br />who shall initially detennine which information is subject to privacy e~elusions pursuant to the <br />Texas Public Infonnation Act. <br /> <br />Do you want to request that certain information within your personnel file be excluded from public <br />access? <br /> <br />. 'l. ,: r. <br />- .. '-'''-' .-p'- <br />e:. .~ .~ :;-:'~I' . <br /> <br />. ;",' .-.,:_,.:" ~.:' :;-;~.. <br /> <br />. .[ ] YES ". . <br /> <br />[v1"NO <br /> <br />.' ". <br />. .... ..... "..- <br />. ~... "'r. <br />o r '__'. . <br /> <br />~ ~ r.- ~:"!':-:o. .:t. ::. -"t.. '.o::':..:~.-..t: . .: <br /> <br />. ~~;.:..\....:. <br /> <br />u;' . ~: '-::.- ':.~:." <br /> <br />. ".' ~J'" .... ..... . ..:. -......... . <br /> <br />L ~ Z. ~~/c.. <br />Print Name <br /> <br />~~ <br />mployee Signatur~ <br />