OPEN RECORDS REQUEST FORM
Date:
Name of requestor:
(Please print)
Company name (if applicable):
Mailing address:
City: State: Zip code:
Phone number:
Documents requested: Please be as specific as possible in describing the documents you wish
to inspect. If your inquiry involves real property, please list the address:
Signature of requestor:
For LFUCG Use Only
Received by:
(Please print)
Date received:
Date response sent:
(No more than 3 days after receipt of request.)
Log number:
For recordkeeping purposes, please place this request with a copy of the response
and retain for a minimum of one (1) year.
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signature
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