Open Records Request Form

Date of Request: 
 (mm/dd/yyyy)

Request Document:  

Name of Requester:   

Street Address:  

City State Zip:    

Telephone:       

Email Address:  

Records Requested:
*Provide as much specific detail as possible so the agency can identify the information
 

Do You Want Copies?  Yes or No

Do You Want To Inspect The Records?  Yes or No

Do You Want Certified Copies of Records?   Yes  or  No