Your name:*

Representing (firm/company/group):

I hereby request public records pursuant to the California Public Records Act, Government Code Section 6250-6258

Title/Document Description:*

Date/Period:*

# of copies:*

Attachment:

I understand there is a fee for duplication/reproduction of all documents that I request and I agree to pay the fee for paper copies at the rate set forth in adopted fee schedule per Resolution No. 2007-59. (Other fees may be applicable per Resolution 2007-59). Fee will be paid prior to any duplication of documents. *

Yes

No

Phone Number:*

Email Address:*

Mailing address:*

City:*

Zip*