2. 

3. Johnson County Park Police

   7900 Renner Road, Shawnee Mission, KS 66219-9723

   Phone (913) 438-7252 | Fax (913) 438-8074

   Kansas Open Records Act Request Form

   Read carefully before filling out form

5. “No person shall knowingly sell, give or receive, for the purpose of selling or offering for sale any property or service to persons listed therein, any list of names and addresses contained in or derived from public records…” K.S.A. 45-230(a).  Violation of this law may subject the violator to a civil penalty of $500.00 for each violation. 

   By signing this request form, the requester makes the following certification pursuant to K.S.A 45-220(c)(2): "the requester does not intend to, and will not: (A) Use any list of names or addresses contained in or derived from the records or information for the purpose of selling or offering for sale any property or service to any person listed or to any person who resides at any address listed; or (B) sell, give or otherwise make available to any person any list of names or addresses contained in or derived from the records or information for the purpose of allowing that person to sell or offer for sale any property or service to any person listed or to any person who resides at any address listed."

7. Requester Information

9. Name*

   First and Last

11. Telephone*
12. Fax (optional)
14. Address*
16. City*
17. State*
18. Zip Code*
20. Email Address*
22. Return Report Via:*

    Select one

    1. Mail

    1. Fax

    1. Pick up at station
24. Requested Records (please specify)*
26. Reason for Request

    Please note: Providing this information is OPTIONAL. It will not be used to determine whether a request is granted or denied. Providing this information may be useful for staff to determine what records are being sought to ensure the requestor is receiving the desired information.

28. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
30. Electronic Signature*
31. Date of request
    Date of request

33. Most records will be returned within three business days from the date the request is received by our office. Reports cannot be emailed.  All reports are disseminated in accordance with the Kansas Open Records Act (K.O.R.A.).

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field