Public Records Request
The following request is made under Indiana Code 5-14-3
Today's Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Organization
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Name(s) of documents requested:
*
If the document name is not known, provide a brief, specific description of the document requested.
In what form do you wish to receive the documents?
*
Electronic Copy (PDF)
Paper Copy (applicable copy fees must be paid before releasing documents)
Signature
*
Please verify that you are human
*
Submit
Should be Empty: