Request - Record Portal

Complete this form to request documents. Each request requires an $8.00 payment. Requests are processed weekly. Allow 7 days for a reply.

I am requesting information on my personal records

I am a 3rd Party requesting Information on another person

Records Holder (Select name of entity you are requesting information from)

First name

Last name

Reason for Request

Type of Request

Describe Request (Documents, Time Period, Years, etc.)

Email Address

Phone Number (999) 999-9999

Delivery: How do you want the information returned?

US Mail

Fax

Fax Number (999) 999-9999

Upload Record Request Documentation Optional

Upload file

or drag and drop

DOC, DOCX, PDF up to 8MB

Payment Method

Each request requires an $8.00 payment.

Credit Card - ($8.00)

Code