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Public Records Inspection & Copy Request Form

2. Name of Requester

3. Affiliation

5. Mailing Address

7. City

8. State

9. Zip Code

11. Phone Number

12. Fax Number

14. Email Address

16. I wish to request the following public records pursuant to the California Public Records Act:

18. Title / Document

20. Description of Document

22. Date / Year of Document

    1. Inspect Only
    2. Request Copies

23. If requesting copies, indicate copy amount:

25. How will you receive copies?

    1. Mail Copies
    2. Will Pick Up Copies

27. Note:
    I understand that there is a charge for duplication of all materials that I may request and I agree to pay for those copies before receiving the material.

    I understand that there is a charge for duplication of all materials that I may request and I agree to pay for those copies before receiving the material.

29. Electronic Signature Agreement

Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field