Name * Enter first and last name. Business Name or Agent * Mailing Address * City * State * Zip Code * Phone Number * Fax Number Email Address * Description of Request Records * Please provide as much information as possible. Pursuant to O.C.G.A. § 50-18-70, et. Sequence, I am formally requesting to: * - Select -Inspect/Review RecordsObtain Copies of Records Do copies need to be certified? * Yes (Additional Fees Will Apply) No Preferred Manner of Delivery * - Select -EmailFaxPick up in personMail - Additional Fees Will Apply Acknowledgement of Person Requesting Records * Yes No Leave this field blank
