Freedom of Information Act Request Form

Requestor's Name (or Business Name, If applicable):

Street Address:

City:

State:

Zip Code:

Phone Number:

Email Address (Optional):

Date of Request:

Description of Records Requested:

Would you like copies of the records certified? (A fee of $1.00 will be charged for each certification.)

Yes

Is the reason for this request a "commercial purpose" as defined in the Act? ("Commercial purpose" means the use of any part of a public record in any form for sale, resale, or solicitation or advertisement for sale or services.)

Yes

Preferred format for receiving records (if available):

Paper Copies

Electronic (PDF/Digital Scan)

Inspection in Person

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