Department of
Environmental Quality

Request to Examine and/or Copy Public Records

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Title:	First Name:	Last Name:
Mr. Ms. *	*	*

Business Name, Affiliation or Representation: *

Telephone 000.000.0000: *

Fax 000.000.0000:

Email: * Mailing Address: *

Zip (ex.: 00000): *

City:

State:

Description of public records requested for disclosure:

Please include as much detail as possible. The more specific, the better we are able to respond to your request.

*

Optional file attachment:

Idaho State Code exempts certain documents from public disclosure, in which case, you will be notified.

USE OF ANY LIST AS A MAILING LIST OR TELEPHONE LIST IS PROHIBITED BY IDAHO CODE §74-120 AND PUNISHABLE BY A CIVIL PENALTY UP TO $1,000.

By submitting this public records request, I certify that I will not use disclosed information for an illegal purpose. I also agree to reimburse the Idaho Department of Environmental Quality according to the established fee schedule.

 

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