I hereby request, pursuant to Idaho Code ?74-102, to examine and/or copy the following public records:

Select all that apply:
These records specifically pertain to myself.
I wish to merely examine these records.
I wish to obtain copies of these records.

Full Name

Address City State Zip Code

Phone

Signature
I acknowledge by my signature that the records sought by this request will not be used for mailing list or telephone list as set forth in Idaho Code §74-120.