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2. Name of Person Requesting Information:*
3. Telephone Number:*
5. Mailing Address:*
7. City:*
8. State: *
9. Zip:*
11. Physical Address (if different than mailing):
13. Detailed Description of Records Request: *
15. Date of Request:*
16. How would you like to recieve this information?
    -- Select One --PickupMailEmail
18. I acknowledge payment will be made based on the Open Records Fee Schedule.*

    1. Yes
    2. No
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

* indicates a required field