Written Request for Release of Information

Requestor's Information

First Name (required):

Last Name (required):

Mailing Address (required):

City, State, Zipcode (required):

Phone (required):

E-mail:

Please Indicate How to Provide Records (required):
EmailMailReview at Public Counter

Cost Information

• $.10 per page single sided & $.15 for double sided paper copies
• 
Mailing costs are dependent on the USPS rates, materials requested, volume of records, etc.

Records Requested:

Please describe to the best of your ability the identifiable record(s) you are requesting. Government Code Section 6253(c) provides public agencies up to 10 days to determine if a record being requested is a public document. In no case will this provision be used as a reason to delay delivery of a document. In the event the document cannot be provided you will receive a written explanation of the cause for non-release. Please be very specific in your request and if possible describe type, date, subject, title, site address, location, etc. of all records requested:

I, , certify under penalty of perjury that to the best of my knowledge all the information I included on this e-form is true.