Public Records Request
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Mr.
Ms.
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First:
Middle:
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Last:
Company:
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Daytime Phone:
(xxx-xxx-xxxx)
Cell or
Other Phone:
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Mailing Address:
Suite/Apt.
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City:
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State:
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Zip:
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Email Addr:
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Re-Enter
Email Addr:
Preferred
Delivery Method:
Select One
Copy
Electronic
Inspect
Fax Number:
Court Records Request
Labels flagged with a
*
indicate a required field.
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RECORD SPECIFIC INFORMATION
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First Name:
Middle:
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Last:
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Date of Birth:
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Drivers License/ID number:
Incident Date/Time:
Time:
AM
PM
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Description of Request
(Please include as much detailed information as possible, as this will help us better serve you.)
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Documents need to be:
1) Not Certified
2) Certified
Public Records Request by Destiny Software, Inc.