Texas Public Information Act

ATTACHMENT 2

Public Information Charges Invoice                                                                           Date:   

Name:                                                                                                                                 Method of Payment:

Agency/Company:                                                                                                                 Cash:                 _____________
 
Address:                                                                                                                                   Check:               ____________

City:                                              State:                                    Zip:                                       Money Order:  _____________

 

Description of Information :

 

  

Personnel Hours:                                                                                       Total Personnel Hours:

(on this request)                                                                                             (current fiscal year)

________________                                                                                     ________________

 



Number

 

  Total         

 

Standard-size Paper Copies _______ @ $.10/page

 

$______________

Nonstandard-size
  - Diskette _______ @ $1.00/each $______________
  - Magnetic Tape _______ actual cost $______________
   - Data Cartridge _______ actual cost $______________
   - Tape Cartridge _______ actual cost $______________
  - VHS Video Cassette _______ @ $2.50/each $______________
  - Audio Cassette _______ @ $1.00/each $______________
  - Rewriteable CD (CD-RW) _______ @ $1.00/each $______________
  - Non - Rewriteable CD (CD-R) @ $1.00/each $______________
   - Digital Video Disc (DVD) _______ @ $3.00/each $______________
   - JAZ Drive _______ actual cost $______________
   - Other Electronic Media _______ actual cost $______________
   - Oversized Paper Copy _______ @ $.50/each $______________
   - Specialty Paper _______ actual cost $______________
   ( blueline, blueprint, mylar, map, photographic)
   - Other _______ actual cost $______________
  Personnel Charges:    

 

 

  - Programming _______ @$28.50/hour

$______________
  -Other Personnel _______ @$15.00/hour

$______________
Overhead Charges:

 

 

  (20% of Total Personnel Charges) _______ x $.20 $______________
Microfiche or microfilm charges:

 

 
  - Paper copy _______ @ $.10/page $______________
  - Fiche or film copy _______ actual cost $______________
Remote document retrieval _______ actual cost

$______________

 
Computer Resource Charges:

 

 
  - Mainframe _______ @ $10.00/min $______________
  - Midsize _______ @ $1.50/min. $______________
  - Client/Server _______ @ $2.20/hour $______________
  - PC or LAN _______ @ $1.00/hour $______________
       
Miscellaneous supplies _______ actual cost $______________
Postage/Shipping Charges _______ actual cost $______________
Photographs _______ actual cost $______________
Other costs _______ actual cost $______________
Outsourced/Contracted Services _______ actual cost $______________
Other Pmts. Applied: (Subtract Deposit Paid) _______ actualy paid - $______________
Total Due:

 

$______________

 

*sales tax is not applicable on public information  
   
Please make check payable to:  
   
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