2. To receive acknowledgement of your records request, please provide an email address, phone number or mailing address.
4. Name*
5. Company Name
7. Address
9. City
10. State
11. Zip Code
13. Phone Number*
14. Email Address*

16. Describe the nature of the request, specifically identifying the public records being requested. The Agency encourages as much specificity as possible in the request to enable the Agency to more efficiently locate and provide the requested records.

18. Description of Requested Records*
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20. 1. Receive an email copy of this form.
21. Email address

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