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2. Date*
   Date
4. First Name*
5. Last Name*
7. Address*
9. Address 2
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Email Address*
18. Is this a commercial request?*

    1. Yes

    1. No
20. Records*

    Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible.

22. Department*

    1. Administration (agendas, minutes, meetings)
    2. Board of Supervisors (resolutions, proclamations)
    3. Circuit Court (deeds, land records, marriage licenses, divorce records, ancestry)
    4. Commissioner of the Revenue (property cards, land use, tax assessments)
    5. Community Development (permits, inspections, zoning complaints, plans/plats)
    6. Finance & Budget (payroll, expenditures warrants)
    7. Fire & Rescue (incident reports, medical reports, fire permits)
    8. Human Resources (employment verification, job descriptions)

    1. Parks & Recreation (programming, vendors)
    2. Procurement (Awarded & Solicited Bids)
    3. Service Authority (drinking water quality reports, testing results, water use, system repairs)
    4. Sheriff (crime reports, arrests)
    5. Registrar (voter record, candidate information, ballots)
    6. Treasurer (tax payments)
    7. Other

24. I understand that FOIA allows the County to make reasonable charges for accessing, duplicating, supplying, or searching for requested records. FOIA allows the County to charge for the actual costs of responding to FOIA requests. 

    I understand if the County is owed money from a previous FOIA request that has remained unpaid for more than 30 days, the County may require payment of the past-due bill before it will respond to any new FOIA request from the delinquent requester.

26. Do you agree?

    By checking I agree, you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.

    1. I Agree
28. Signature of person making the request*

    The County will respond to this request withing five (5) working days.

Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit Submit and Print

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