Records Request Form Public Disclosure Request Form Date of request* MM slash DD slash YYYY Name of requestor* First Last Signature of requestor may be verified or required on delivery of records.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Items requested*Please be specific, include time-frame as appropriate.Notices: If the information and/or record you have requested is within one of the exceptions from disclosure as stated in the Public Information Act, you will be advised. In accordance with the ADA, the Public Information Officer will provide copies of requested documents in an alternate format to persons with disabilities at no additional charge.CAPTCHA