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Public Records Request for Application Documents ONLY

Costs: (will be invoiced) Duplication Charges (see Duplication Charges table)
Written Certification of Documents - $25 fee in addition to duplication charges. You may complete the form and submit from your computer.

 

Certification Required (Additional Charge of $25.00)    
Certification NOT Required
Individual to be
Researched:		 First Name or Business Name:    
Middle Name or Initial:
Last Name:
License Number: Profession:
Document Type
(all that apply)		 Application Documents (complete file)  Application ONLY
Other:
Additional identifying information (address, school, etc.) or special instructions to processor: Limit of 4 lines.

Documents are to be sent to:

Contact: Phone Number:
Company:
Email:
Street Address:
City:
State: Zip Code:

If you would like to take our optional survey please click the link: Public Records Request Survey