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2. 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.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

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