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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.
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