Request Public Records

2. First Name*

3. Last Name*

5. Address1

7. Address2

9. City

10. State

11. Zip

13. Email Address*

15. Home Phone Number*

16. Business Phone Number

17. Fax Number

19. Request Received:
    Request Received:

    Request Received:

20. Request Received:
    -- Select One --In PersonMailPhoneFax

22. Report Number (If Known):

24. Specific Records Requested / Reason:*

    Please let us know what records you are requesting.

28. Status:
    -- Select One --ApprovedDenied

29. Approved / Denied By:

30. Date:
    Date:

32. Reason for Denial:

34. Records Distributed:
    -- Select One --In PersonMailFax

35. Distribution Date:
    Distribution Date:

37. Number of Copies:

    25 cents each

38. Total Cost:

40. Request Received by:

41. Date:
    Date:

Leave This Blank:


42. 1. Receive email copy
43. Email address

    This field is not part of the form submission.

44. Submit

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