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2. Requester's Address is your mailing address. Address for records must be included in the description.
3. First Name*
4. Last Name*
6. Requester's Address 1*
7. Address 2
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address*
16. I would like to:*

    1. View/Inspect Records
    2. Receive Hard Copies of Records
    3. Receive Electronic Copies of Records
18. Describe the records requested with reasonable specificity (type of record, related addresses, etc. - NO POLICE RECORDS). *
19. Millcreek does not maintain Unified Police Department (UPD) police records.
21. Fees may be associated with this request. Do you agree to pay them according to Millcreek's Consolidated Fee Schedule?*

    1. Yes
    2. No
    3. Request Fee Waiver
22. If requesting a fee waiver, please provide reasoning per UCA 63G-2-203(4).*
24. Associated costs include staff time to search, compile, and/or redact.
    Consolidated Fee Schedule
26. If the records are not public, please explain why you should be entitled access.
Leave This Blank:


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

    This field is not part of the form submission.

30. Submit Submit and Print

* indicates a required field