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Records Request Form

  1. NOTE: WE CAN ONLY MAIL OR FAX REPORTS. WE ARE UNABLE TO EMAIL AT THIS TIME. PLEASE PROVIDE A MAILING ADDRESS OR FAX NUMBER.

  2. Type of Request (check all that apply)*

  3. Pecuniary Gain Statement*

  4. NOTE: IF THE REQUESTED REPORT REQUIRES REDACTION, WE MAY NEED YOU TO ESTABLISH YOUR IDENTITY BY PROVIDING A COPY OF YOUR IDENTIFICATION.

  5. Leave This Blank:

  6. This field is not part of the form submission.