Public Record Request

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Public Record Request

Date of request:                                            __________________________      

Requestor name if given:                                          _______________________

How to contact them:                                                                      ____________

________________________________________________________________________________

Reason for request if they volunteer the information:

________________________________________________________________________________

Information requested:                                                                                              

Dates of information requested:                                                                                

What choice of media do they want the data:

             Paper copies are 25 cents per page plus postage

             Email is free

             Cost for CD ($1) plus postage

Date employee called for follow-up if needed:                                            

Date of request completion:                                                     __________

Requestor’s choice as to mode of delivery:              mail                pickup       email

List of any data that was redacted due to privacy laws:________________________

Submit request:        Drop off - 2700 Columbus Avenue, Sandusky, Oh

                                 Fax - 419-625-9622 

                                 Email - [email protected]

Telephone request will not be accepted.

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