Date Requested: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019202020212022 Name of Requestor: Address: City: State: - None -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Phone Number: Please enter a valid ten-digit phone number (e.g. 999-999-9999) Email: Note: an electronic copy of this request will be sent to the above email address as a receipt of the request. You must keep this email in order to file an appeal. Records Requested: Provide as much specific detail as possible so the agency can identify the information. Do you want copies? NoYes Do you want to inspect the records? NoYes Do you want certified copies of records? NoYes Submit Disclaimer: Please note that you must keep the emailed version of this request in order to file an appeal. Disclaimer about abusing the RTK system, legal action Note about potential fees and cost associated with making this request.