Open Records Request

OPEN RECORDS REQUEST
DeKalb Public Health- Open Records Request
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
To:
Fax:
Is this an Environmental Health Records Requests?
Pursuant to the Georgia Open Records Act (O.C.G.A. § 50-18-70 et seq.), I am requesting the following records:
Full Name:
Please provide full name: John Smith
I can be contacted at:
Company Name
Company Address
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email:
example@example.com
If you have any supplemental information you would like to provide as a part of this request (i.e. letters, emails, etc.) please add them below
File Upload

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Cancelof
Should be Empty:

OPEN RECORDS REQUEST