This Form Is A Request For Public Records.

Public Records Request

Date

Requester’s Information

Name

Phone

Organization

Mailing Address

Public Records Act of Louisiana, R.S. 44:1 et seq., I hereby request the following records from Tangipahoa Parish Government:

Description of Request (The request must be clear to enable the Parish to conduct a meaningful search. The Parish may ask questions about the request to respond to it fully and in a timely manner. Be as specific as possible, including names, dates, etc., if known) If you have any supplemental information as a part of this request (i.e., letters, email) Place attach to the form):

Please Choose One Of The Following:

I wish to have copies made (prepayment required)

I wish to review the records before copies are made

Mail Records (prepayment required including postage)

I wish to review records only (no charge)

Fax records to:Fax records to:

In making this request, I understand the Parish is under no obligation to create a document to satisfy my request. I further understand that the records will be released only in accordance with R.S. 44:33. If the parish determines that a charge(s) will be applied, a written estimate of charges will be provided to the requester. Receipt of a deposit will also be required prior to providing requested documents.

Signature(type full name)

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Date

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