2. Full Name
4. Company Name
6. Mailing Address
8. City
9. State
10. Zip
12. Phone Number
13. Email Address*
17. Description of Requested Record(s)

    (Describe the specific public record(s) e.g., date, type, time period covering documents requested etc)

21. Please note that information contained in any public record may be subject to Minnesota Statute 13.04.

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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