§2701.APPENDIX A. Office of Public Counsel Request for Public Records

Date of request:
Name:
Mailing address:
City, State, and zip code:
Daytime (8am-5:30pm) telephone number:
Whom are you representing?
Please state the specific purpose for the request:
Please identify the information that you would like to review:
Please state how you would like to review this material (circle the appropriate number):
		1.	I would like to inspect, but not copy, this material.
		2.	I would like a copy of this material.
		3.	I would like to inspect and copy this material.

 

If you want a certified copy of any of the documents that are being copied, please identify
which documents you want certified:
Additional comments:
Please sign your name				Date of signature