Forms • Public Record Access Form

Public Record Access Form

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To (Name of Public Body)*
Your Name*
Date of Request*
Your Mailing Address*
Your Telephone Number
Your Email Address
Records Requested (BE AS SPECIFIC AS POSSIBLE) Describe types of records, dates, parties to correspondence, subject matter, etc. The public body will make every reasonable effort to assist you in identifying the record being sought. Requests for voluminous records may be delayed.*
PLEASE CONTACT ME IF COSTS WILL BE GREATER THAN AMOUNT LISTED There may be costs involved in responding to your request. The public body can require you to examine the records at the office of the public body. Refer to the public body’s policy or regulations for information about costs and access to records.*

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