Public Disclosure Request
*
Date of Request
*
Name
*
Address
*
Phone
*
Email Address
I request to inspect my central file
This request has been previously submitted or is currently with the Department.
Date of Original Request
Original Request Submitted to (Name/Address)
I request copies of the following public records. If requesting offender records, include offender name and DOC number.
*
In order for us to fulfill your request we might need to contact you via phone or email.
I will allow DOC to contact me via phone (if provided) or email.
*
Indicates Response Required