3. To be completed by the person making the request:
5. Name*
6. DOB*
   DOB
8. Maiden Name (if any):
10. Address*
12. City*
13. State*
14. Zip Code*
16. Email Address*
18. Home Phone
19. Cell Phone
21. I request under the Freedom of Information Law, the following records:*
    please be specific on the records you are requesting, i.e. arrest records, incident records, domestic incident records, motor vehicle accident records, complaints, etc.
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23. 1. Receive an email copy of this form.
24. Email address

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