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APPLICATION FOR PUBLIC ACCESS TO RECORDS (FOIL)

  1. (If individual First, MI, Last)

  2. Street Number, Street Name, City, State, Zip Code

  3. Please be as specific as possible, including time periods, names, etc. to help ensure proper record retrieval.

  4. Signature

  5. Street #, Street Name, (or P.O. Box #), City, State, Zip Code

  6. (Area Code) XXX-XXXX

  7. DENIED FOR THE REASON(S) CHECKED BELOW:

  8. MM-DD-YYYY

  9. Sign and Date

  10. Leave This Blank: