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2. Requestor's First Name*
3. Requestor's Last Name*
5. Company/Organization
7. Mailing Address*
9. City*
10. State*
11. Zip*
13. Email Address
14. Phone Number
15. Fax
17. Description of Requested Record(s)*
    Describe the records you wish to receive. Include Date(s) of Birth for police records. In order to expedite the search for public records, be as specific as possible.
19. Indicate Form of Retrieval*

    1. Pick-up
    2. Mail

    1. Email
    2. Fax
20. I give permission to redact any information that is confidential pursuant to Section 552 of the Texas Government Code (Open Records Act)*

    1. Yes

    1. No
22. Attachments, If Any
23. Date of Request
    Date of Request
24. Signature of Requestor
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit Submit and Print

* indicates a required field