EmailMe Form - (APD) APPLICATION FOR PUBLIC ACCESS TO RECORDS

How to Receive Records *

Please mail to my address

Please call for pick up

Applicant's Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Date of FOIA Request

MM / DD / YYYY

Phone *

### - ### - ####

Incident Date

MM / DD / YYYY

I hereby apply to inspect the following records: *

Please ensure that you include the case or incident number and any other relevant information pertaining to your request.

Signature *

Clear

Under the Freedom of Information Act I am requesting access to the above listed records. If any part of this request is denied please give a specific reason for the refusal to release the information and notify me of the appeal procedures available under the law.