Request for Records Form

Request for Records Form
Date

MonthDayYear
Date
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
I am requesting a copy of the following records from my file. To expedite the request please be as specific as possible in describing the records being requested.
Fees are .25 for each page. Payment must be received before copies are made. We will provide copies only; any originals received by the Housing Authority will not be returned. Please allow seven business days for the request to be processed. Copies must be picked up in person.
Should be Empty: