Public Records Request

First Name

Last Name

Preferred Pronoun

Organization

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email

Phone Number

Please describe the records you are requesting and provide as much specificity as possible, including applicable date ranges.

This public records request, including any associated correspondence, will be considered a public record in its entirety. As such, it will be made available to any member of the public upon request.
Do not include any sensitive information, such as medical information, financial account numbers, or Social Security numbers. The ADS will contact you if additional information is required.
Submission of this form does not constitute receipt of it by the ADS. Your public records request will be considered received on the next business day following its submission.

I agree that I have read the directions and disclaimers on this form and that the information that I have provided is accurate to the best of my knowledge. Clicking the Declaration below is equivalent to my electronic signature.

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Date Submitted

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