Office of General Counsel | Patton Hall, Room 304
P.O. Box 315 | Normal, AL 35762
Phone (256) 372-8889 | Fax (256) 372-8890
Revised 4/20/11
OPEN RECORDS REQUEST FORM
DATE REQUESTED: ________________
REQUEST SUBMITTED BY (please circle one): EMAIL / U.S. MAIL / FAX / IN PERSON
NAME OF REQUESTER: _______________________________________________________
REQUESTER STREET ADDRESS (Required): ______________________________________
CITY/STATE/COUNTY/ZIP (Required): ___________________________________________
TELEPHONE: ______________________ EMAIL: ____________________________
RECORDS REQUESTED: *Provide as much specific detail as possible so the agency can identify the
information. Please use additional sheets if necessary.
DO YOU WANT COPIES (please circle one)? YES or NO
DO YOU WANT TO INSPECT THE RECORDS ON SITE? YES OR NO
DO YOU WANT CERTIFIED COPIES OF RECORDS? (Certification fee may apply) YES OR
NO
______________________________________________________________________________
FOR AGENCY USE ONLY
DATE RECEIVED:
