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2. First Name*
3. Last Name*
5. Description of Request*
   Provide a detailed description of the records that you are requesting. Be as specific as possible.
7. How Would You Like to Receive the Request?*

   1. Email
   2. Mail
   3. Pick-Up in Person
8. Requested Timeframe
   What is the requested date that you would like to receive the request?
10. Email Address*
11. Phone Number*
13. Address1
15. Address2
17. City
18. State
19. Zip
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21. 1. Receive an email copy of this form.
22. Email address

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23. Submit Submit and Print

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