Open Records Request

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Phone

Description on Records Requested (Be specific- dates, types of documents, run number(s),etc.)

Preferred Format

Electronic (email)

Hardcopy (mail)

In person review

Timeframe Covered by request (Start date-End Date)

Purpose of Request

"I understand that this request is subject to the Kentucky Open Records Act (KRS 61.870 - 61.884) and that certain records may be exempt from disclosure."

I understand that Kentucky law requires a response within 5 business days.

Date Requested

Signature

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