If any officer mentioned in Section 63-17-5 shall fail, neglect or refuse, upon request of any person who shall declare himself to be interested, to perform any act authorized in said section, or to furnish a written statement to such person, showing the result of such examination and inquiry, such officer shall be subject to the penalties prescribed by law. Any such request of such officer shall be accompanied by payment, or tender, of a fee of one dollar for each examination, and fifty cents a mile for each mile or fraction thereof over one-fourth, going to and returning from the place of examination; moreover, the place shall not be more than five miles distant and within the jurisdiction of the officer.