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2. Name*
4. Phone Number*
5. Email Address*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Delivery Options

    1. Please email me these records if possible.
    2. Please advise me of the appropriate time during normal business hours for inspecting these records prior to obtaining copies.
    3. Please inform me of the cost of providing physical copies (such as photocopies, tapes or DVDs) of these records. Physical copies will be mailed after payment is received.
15. Description of Records*
    Include as much detail about the record as possible, such as relevant dates, names, descriptions, etc.
17. If Records Can't be Emailed

    1. If all the requested records cannot be emailed to me, please advise me of the portions that can be emailed and advise me of the cost for reproducing the remainder of the records requested.
    2. If the requested records cannot be emailed to me due to the volume of records identified in response to my request, please advise me of the actual cost of copying all records onto a CD or floppy disk.

    Reproducing hard copies cost $0.25 per page or actual cost of reproduction.
19. If my request is too broad, does not reasonably describe the records or cannot be completely sent by email, please contact me so that I may clarify my request, and when appropriate inform me of the manner in which records are filed, retrieved or generated.

    1. By email
    2. By phone
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21. 1. Receive an email copy of this form.
22. Email address

    This field is not part of the form submission.

23. Submit

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