Public Information Request Form Citizen Request for Law Enforcement Records Only

Public Information Request Form Citizen Request for Law Enforcement Records Only
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The date I will check back:
If no follow-up by requestor within 30 days, request is voided (by law).
Preferred method(s) of contact for response:(Be sure to enter the appropriate information in the next box)
Supply the contact information (Phone Number, Mailing Address, or Fax Number)
Reply Email: (this is your email address)
youremail@example.com