A Office of Public Counsel Request for Public Records

Section 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