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2. 
4. Request for Records Pursuant to Indiana Access to Public Records Act (I.C. 5-14-3-1, et seq., as amended)
   Thank you for your interest in requesting records. Please give the following information:
6. First Name*
7. Middle Name
8. Last Name*
10. Address 1*
12. City*
13. State*
14. Zip*
16. Phone Number*
17. Fax Number
18. Email Address
20. I am requesting the following information:*
    Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible.
22. Date range *
24. The City of New Haven may correspond with me regarding this request*

    1. by email (include above)
    2. by mail
    3. by fax (include above)
26. By signing this document, I understand that the city may charge a fee for providing copies of the requested public records, following the General Reproduction fee table.*
27. General Reproduction fee table
    General Reproduction fee
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field