REQUESTER INFORMATION

Full Name:*  
Date:*  
Company Name:*  
Mailing Address:*  
City/State/Zip Code:*  
Phone No. (xxx-xxx-xxxx):*    
Email Address:*    
Preferred method of contact in
the event of questions: *
 


DESCRIPTION OF REQUESTED RECORD(S):
(Describe the specific public record(s) e.g., date, type, time period covering documents requested etc) *

 

I understand that I will be contacted once documents have been identified. If production of records is requested, an estimated cost will be provided to me and I agree that I will be required to submit payment for duplication costs (and mailing) prior to the production of the requested documents. *

 
Please note that information contained in any PRA request is a public record and may be subject to public inspection pursuant to the CA Public Records Act.
By submitting this form, this serves as my online signature:    
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