MDA Webforms | Open-Record-Sunshine-Request

Please DO NOT include any personal, confidential, and/or sensitive information in your responses on this form (e.g. social security number, credit card information, health information, account number, etc.).

Contact Information

Prefix

Last Name *

First Name *

Middle Initial

Suffix

Business Name*

Address 1*

Address 2

City*

State*

County

Zip Code *

Ext. -

Primary Phone*

* x

Phone Type * Ext.

Alternate Phone 1

* x

Phone Type * Ext.

Alternate Phone 2

* x

Phone Type * Ext.

Alternate Phone 3

* x

Phone Type * Ext.

E-mail Address*

Confirm E-mail Address

Information Requested

Provide specific details of information requested? *

detailed description of information

Describe beginning and end dates associated with request.

Describe beginning and end dates associated with request

Date information is needed by.*

Please select one*:

I would prefer to come and view any responsive documents, rather than receive copies.

Contact me regarding the scope of my request, any associated costs, and manner of production.

I would like to receive my copies in this manner, i.e., hard copy, email, USB flash drive, etc.

Signature

I certify this information is correct

Legal Name*

Date 11/21/2024

Open Record Sunshine Request