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2. Please allow 10 business days for response/ 20 days if confidential.

4. Name*
6. Organization (if applicable)
8. Address*
10. City*
11. State*
12. Zip Code*
14. Phone Number*
15. Email Address*
17. INFORMATION BEING REQUESTED

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19. Date Range:
    Date Range: Start Date

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    Date Range: End Date
20. Check here if records are not specific to a date.

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22. Method for providing record to you.*

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    1. Email
    2. Mail
    3. In Person
24. Description of records being requested:*
28. Office Use Only
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33. 1. Receive an email copy of this form.
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