Board of Elections

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Printable Request for Access to Public Records

Instructions: All persons submitting a request to access public records must complete the following:

* indicates a required field

Field Name	Field Input
*Name
*Address
*City
*State
*Zip
Day Phone
*E-mail

*Date: *Applicant Signature:

Does Applicant apply on own behalf? Yes No

If No, name and address of person or organization on whose behalf applicant is acting.

Field Name	Field Input
Name
Address
City
State
Zip

Please list the records, determinations, minutes, rules or other documents you wish to examine or have copied. (Photocopy charge: $.25 per page, prepaid).