Open Records Request Form

2. To be completed, electronically signed, and dated by person making request.

   To be completed, electronically signed, and dated by person making request.

4. Name

6. Address

8. City

9. State

10. Zip Code

12. Phone

13. Email

15. Identify the County Department or Official to whom this request is submitted:

17. State whether you wish to inspect and/or obtain photocopies of the requested records:

19. Identify the specific records covered by this request:

21. Date of Request
    Date of Request

23. Initial here for signature:

25. Notice

    Some public records are exempted from disclosure by law. You will be notified within three(3) business days if the record sought is a public record available for inspection, and you will be notified when the record will be available for inspection and/or copying. You will be charged $.10 for each page of our records you request to have copied, and may be charged an additional fee for certified copies or for other copies for which a fee is specifically authorized or otherwise provided by law. In addition, you may also be charged a reasonable fee for search, retrieval, and other direct administrative costs if your request necessitates an unusual administrative cost or burden.

    Some public records are exempted from disclosure by law. You will be notified within three(3) business days if the record sought is a public record available for inspection, and you will be notified when the record will be available for inspection and/or copying. You will be charged $.10 for each page of our records you request to have copied, and may be charged an additional fee for certified copies or for other copies for which a fee is specifically authorized or otherwise provided by law. In addition, you may also be charged a reasonable fee for search, retrieval, and other direct administrative costs if your request necessitates an unusual administrative cost or burden.

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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field