IHCDA Public Records Request

ACCESS TO PUBLIC RECORDS REQUEST
REQUESTING PARTY
Name*

First NameLast Name
Organization
(if applicable)
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
REQUESTED RECORDS
Please identify the records requested with reasonable particularity:*
Reason for request:
(optional - for clarification purposes)
Additional Documentation

Attach Files

Cancelof
DELIVERY
Format*

Electronic CopyHard Copy
Please Note: There may be a copying fee of $0.10 per page associated with your request. Electronic records may be available at no charge. Electronic delivery will be sent to the email address listed above.
Requested*

MonthDayYear
HourMinutesAM/PM Option
Should be Empty:

ACCESS TO PUBLIC RECORDS REQUEST