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2. Name
3. Email Address (Required)*
5. Address
7. City
8. State
9. Zip Code
11. Phone Number
13. County Department or Official to whom request is submitted
14. Do you wish to inspect and / or obtain photocopies of the requested records

    1. Yes
    2. No
16. Identify specific records covered by this request
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18. 1. Receive an email copy of this form.
19. Email address

    This field is not part of the form submission.

20. Submit

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