Request For Records

What records would you like sent back to you via email (Include as much detail as possible such as full names, dates, descriptions, etc...)

Cost of copies

Please inform me of the cost of providing paper copies of the following records (Include as much details as possible such as full names, dates, descriptions. etc...)

Records Inspection

Inform me of the appropriate time during business hours for me to inspect the following records prior to obtaining copies

What records would you like to inspect before receiving copies (Include as much detail as possible such as full names, dates, descriptions, etc...)

For records that can not be emailed

For records that can not be emailed to me, please inform me by email of the portions that can be emailed and advise me of the cost for reproducing the remainder of the records requested

What records would you like paper copies of (Include as much detail as possible such as full names, dates, descriptions, etc...)

If your request is too broad or does not reasonably describe the records, we will contact you via email so that you may clarify your request, and when appropriate, indicate the manner in which records

If my request must be modified, I would prefer to be contacted by phone at this number

Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Denied Requests

If for any reason any portion of my request is denied, please inform me of the reason in writing and provide the name, address and email of the person or body to whom an appeal should be directed